Provider Demographics
NPI: | 1932182276 |
---|---|
Name: | LUNA, CARLOS F (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | CARLOS |
Middle Name: | F |
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: | 3131 LA CANADA ST STE 230 |
Mailing Address - Street 2: | |
Mailing Address - City: | LAS VEGAS |
Mailing Address - State: | NV |
Mailing Address - Zip Code: | 89169-2551 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 702-732-1290 |
Mailing Address - Fax: | 702-260-1926 |
Practice Address - Street 1: | 3131 LA CANADA ST STE 230 |
Practice Address - Street 2: | |
Practice Address - City: | LAS VEGAS |
Practice Address - State: | NV |
Practice Address - Zip Code: | 89169-2551 |
Practice Address - Country: | US |
Practice Address - Phone: | 702-732-1290 |
Practice Address - Fax: | 702-260-1926 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-11-21 |
Last Update Date: | 2022-03-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NV | 10609 | 2080P0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NV | 100500105 | Medicaid | |
XPY199976 | Other | MEDI-CAL | |
CC5973 | Other | BLUE CROSS BLUE SHIELD | |
NV | VWCLCQ | Other | MEDICARE- GROUP |
NV | VWCLCQ | Other | MEDICARE- GROUP |
NV | 100500105 | Medicaid |