Provider Demographics
NPI:1952623092
Name:LUNA, MICHAEL (CCC-SLP, MA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:CCC-SLP, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14901 NATIONAL AVE
Mailing Address - Street 2:SUITE # 102
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2637
Mailing Address - Country:US
Mailing Address - Phone:408-358-3631
Mailing Address - Fax:408-358-4537
Practice Address - Street 1:14901 NATIONAL AVE
Practice Address - Street 2:SUITE # 102
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2637
Practice Address - Country:US
Practice Address - Phone:408-358-3631
Practice Address - Fax:408-358-4537
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 10556235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist