Provider Demographics
NPI:1669582466
Name:LUNA, EMILIO (MD)
Entity type:Individual
Prefix:DR
First Name:EMILIO
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10736 W PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-4062
Mailing Address - Country:US
Mailing Address - Phone:623-760-6180
Mailing Address - Fax:
Practice Address - Street 1:4137 N 108TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-5459
Practice Address - Country:US
Practice Address - Phone:623-877-7337
Practice Address - Fax:623-772-0686
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ377438OtherAHCCCS