Basic Information
| Provider Information | |||||||||
| NPI: | 1669582466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUNA | ||||||||
| FirstName: | EMILIO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10736 W PEORIA AVE | ||||||||
| Address2: | |||||||||
| City: | SUN CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853514062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6237606180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4137 N 108TH AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850375459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238777337 | ||||||||
| FaxNumber: | 6237720686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 01/22/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 41114 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 377438 | 01 | AZ | AHCCCS | OTHER |