Basic Information
| Provider Information | |||||||||
| NPI: | 1104042928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUNN | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3756 SANTA ROSALIA DR. ST. 628 | ||||||||
| Address2: | |||||||||
| City: | LA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232938771 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3756 SANTA ROSALIA DR | ||||||||
| Address2: | ST. 628 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900083606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232938771 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 75012 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 75012 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.