Provider Demographics
NPI:1255909065
Name:LUNA, JACQUELINE ROMAN
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ROMAN
Last Name:LUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 JONI LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4952
Mailing Address - Country:US
Mailing Address - Phone:909-705-2989
Mailing Address - Fax:
Practice Address - Street 1:805 JONI LN
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4952
Practice Address - Country:US
Practice Address - Phone:909-705-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program