Basic Information
| Provider Information | |||||||||
| NPI: | 1255920484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUNA | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LISSETE | ||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2423 CLEGHORN ST APT 101 | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968153179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169959030 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 98-1005 MOANALUA RD SPC 410 | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084885555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2021 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.