Provider Demographics
NPI:1669536686
Name:LUNA-BANIQUED, ZITA (MD)
Entity type:Individual
Prefix:
First Name:ZITA
Middle Name:
Last Name:LUNA-BANIQUED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 AMOUR DR
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-5212
Mailing Address - Country:US
Mailing Address - Phone:337-238-9317
Mailing Address - Fax:337-531-3709
Practice Address - Street 1:1585 THIRD ST.
Practice Address - Street 2:BAYNE JONES ACH
Practice Address - City:FORT POLK
Practice Address - State:LA
Practice Address - Zip Code:71459-5110
Practice Address - Country:US
Practice Address - Phone:337-531-3074
Practice Address - Fax:337-531-3709
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37780171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor