Provider Demographics
NPI:1548295058
Name:TIUSECO, KRISTINE ANDREA LUNA (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE ANDREA
Middle Name:LUNA
Last Name:TIUSECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 CANTERWOOD BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5813
Mailing Address - Country:US
Mailing Address - Phone:253-857-1350
Mailing Address - Fax:253-857-1399
Practice Address - Street 1:11511 CANTERWOOD BLVD STE 320
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5813
Practice Address - Country:US
Practice Address - Phone:253-857-1350
Practice Address - Fax:253-857-1399
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46646207R00000X
WAMD00046646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013026Medicaid
P00381981OtherRAILROAD MEDICARE
WA8457319Medicaid
P00381981OtherRAILROAD MEDICARE