Provider Demographics
NPI:1043288590
Name:LUNA, LYDIA A (MD, P A)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:A
Last Name:LUNA
Suffix:
Gender:F
Credentials:MD, P A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 8TH AVE
Mailing Address - Street 2:#602
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4143
Mailing Address - Country:US
Mailing Address - Phone:817-877-1848
Mailing Address - Fax:817-877-3716
Practice Address - Street 1:1307 8TH AVE
Practice Address - Street 2:#602
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4143
Practice Address - Country:US
Practice Address - Phone:817-877-1848
Practice Address - Fax:817-877-3716
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1465207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG279OtherBCBS
TX00G279OtherMEDICARE ID #
TX2937634OtherCIGNA
TX4133080OtherAETNA
TX2937634OtherCIGNA