1376931832 NPI number — LUNA ACUPUNCTURE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376931832 NPI number — LUNA ACUPUNCTURE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUNA ACUPUNCTURE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376931832
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9428 BAYMEADOWS ROAD, SUITE134
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-800-9842
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9428 BAYMEADOWS RD
Provider Second Line Business Practice Location Address:
SUITE 134
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32256-7969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-800-9842
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JEAN-LOUIS
Authorized Official First Name:
NORALIZA
Authorized Official Middle Name:
Authorized Official Title or Position:
ACUPUNCTURE PHYSICIAN
Authorized Official Telephone Number:
904-800-9842

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  3421 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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