Provider Demographics
NPI:1912481169
Name:LUNA ROMERO, ANDREA ESTEFANIA (DO)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ESTEFANIA
Last Name:LUNA ROMERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 MOSSY COVE LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2577
Mailing Address - Country:US
Mailing Address - Phone:610-809-7308
Mailing Address - Fax:
Practice Address - Street 1:3031 W GRAND BLVD STE 600
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3014
Practice Address - Country:US
Practice Address - Phone:610-809-7308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-23
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician