Provider Demographics
NPI:1801212972
Name:DE LUNA, JAMES RYAN TEANO
Entity type:Individual
Prefix:
First Name:JAMES RYAN
Middle Name:TEANO
Last Name:DE LUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 SONOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-7733
Mailing Address - Country:US
Mailing Address - Phone:707-334-3455
Mailing Address - Fax:
Practice Address - Street 1:538 SONOMA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-7733
Practice Address - Country:US
Practice Address - Phone:707-334-3455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)