Provider Demographics
NPI:1144630575
Name:LUNA PLASTIC SURGERY, PC
Entity type:Organization
Organization Name:LUNA PLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUGUEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-892-7820
Mailing Address - Street 1:6335 HOPSITAL PARKWAY SUITE 216
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:678-892-7820
Mailing Address - Fax:678-892-7824
Practice Address - Street 1:6335 HOPSITAL PARKWAY
Practice Address - Street 2:SUITE 216
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:678-892-7820
Practice Address - Fax:678-892-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052862174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty