Provider Demographics
NPI:1508601154
Name:LUNA VITA CORPORATION
Entity type:Organization
Organization Name:LUNA VITA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LISETTE
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELORS DEGREE
Authorized Official - Phone:512-884-5551
Mailing Address - Street 1:8700 MENCHACA RD STE 401
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5375
Mailing Address - Country:US
Mailing Address - Phone:512-884-5551
Mailing Address - Fax:512-884-5551
Practice Address - Street 1:8700 MENCHACA RD STE 401
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5375
Practice Address - Country:US
Practice Address - Phone:512-884-5551
Practice Address - Fax:512-884-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome Health
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty