Basic Information
| Provider Information | |||||||||
| NPI: | 1487174603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUNA | ||||||||
| FirstName: | KEILA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 440519 | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780440519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563198699 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2410 EAST RIVERSIDE DR | ||||||||
| Address2: | SUITE B-1 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123940652 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.