Individual
LUNA S OUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(702) 653-2344
Mailing address
4700 LAS VEGAS BLVD N, NELLIS AFB, NV 89191-6600
(702) 653-2344
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
54810
CA
Other
Enumeration date
08/12/2017
Last updated
01/13/2020
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