Provider Demographics
NPI:1366297186
Name:MIA LUNA SEVICES
Entity type:Organization
Organization Name:MIA LUNA SEVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOCYLN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALEANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-459-0040
Mailing Address - Street 1:205 VAN BUREN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5336
Mailing Address - Country:US
Mailing Address - Phone:703-459-0040
Mailing Address - Fax:
Practice Address - Street 1:205 VAN BUREN ST STE 120
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5336
Practice Address - Country:US
Practice Address - Phone:703-459-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory