Basic Information
| Provider Information | |||||||||
| NPI: | 1568052538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUNA | ||||||||
| FirstName: | IRLANEA | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 89 WABASH AVE APT 11 | ||||||||
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| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951281963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087506194 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 COUNTRY DR | ||||||||
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| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945365356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107924242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2021 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 20791 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.