Provider Demographics
NPI:1669090171
Name:DE LUNA, JOSE HORACIO
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:HORACIO
Last Name:DE LUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7356 RESTFUL SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4302
Mailing Address - Country:US
Mailing Address - Phone:702-677-6353
Mailing Address - Fax:
Practice Address - Street 1:2290 S JONES BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-3170
Practice Address - Country:US
Practice Address - Phone:702-368-2380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health