Provider Demographics
NPI:1205985181
Name:LUNA, LETICIA S (MD PA)
Entity type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:S
Last Name:LUNA
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:
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Mailing Address - Street 1:268 ST PAULS AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5012
Mailing Address - Country:US
Mailing Address - Phone:201-222-6500
Mailing Address - Fax:201-222-6277
Practice Address - Street 1:268 ST PAULS AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5012
Practice Address - Country:US
Practice Address - Phone:201-222-6500
Practice Address - Fax:201-222-6277
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJNJLIC26756MA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D19989Medicare UPIN