Basic Information
| Provider Information | |||||||||
| NPI: | 1639654254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUNA | ||||||||
| FirstName: | GUADALUPE | ||||||||
| MiddleName: | MABEL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2889 ROYAL AVE | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930654759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056577128 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11565 LAUREL CANYON BLVD STE 116 | ||||||||
| Address2: | |||||||||
| City: | SAN FERNANDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913404650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183615030 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2018 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCSW109629 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.