Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO02051 | CA |
N | 222Z00000X | Podiatrist | CPO02051 | CA |
Y | 224P00000X | Prosthetist | CPO02051 | CA |
NPI | 1073744504 |
---|---|
Provider Name | Prof. Lisa Gabriela Luna |
First Address | Fountain Valley, CA 92708-1360 |
Second Address | Fountain Valley, CA 92708-1360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2009 |
Last Update Date | 10/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200115 | CMS NUMBER (01) | CA |