1750747226 NPI number — FERNANDO LUNA FNP

Table of content: FERNANDO LUNA FNP (NPI 1750747226)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750747226 NPI number — FERNANDO LUNA FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUNA
Provider First Name:
FERNANDO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
M

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:
1750747226
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4887
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78502-4887
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-994-3278
Provider Business Mailing Address Fax Number:
956-627-3739

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4316 N MCCOLL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504-2477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-994-3278
Provider Business Practice Location Address Fax Number:
956-627-3739
Provider Enumeration Date:
01/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2015009757 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P02009107 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P02074190 . This is a "RR MEDICARE W/ HEART AND VASCULAR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 688453 . This is a "MEDICARE W/HEART AND VASCULAR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 363990803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8HL878 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8JY346 . This is a "BCBS W/ HEART AND VASCULAR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 36399082 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 476057ZLVQ . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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