Provider Demographics
NPI:1700811601
Name:LUNA, MANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 S SPRUCE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4517
Mailing Address - Country:US
Mailing Address - Phone:650-871-5858
Mailing Address - Fax:650-871-4834
Practice Address - Street 1:161 S SPRUCE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-4517
Practice Address - Country:US
Practice Address - Phone:650-871-5858
Practice Address - Fax:650-871-4834
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0C23460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C234600Medicaid
CAPHY4155330Medicaid
CA00C234600Medicaid
1871690016Medicare UPIN
CA1275703571Medicare NSC
CA1548336423Medicare PIN
CA33360003XMedicare PIN
CA0917720001Medicare PIN
CA00C234600Medicare ID - Type Unspecified