Healthcare Provider Details

I. General information

NPI: 1942862826
Provider Name (Legal Business Name): CIBELE CAROLINA LUNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date: 02/17/2020
Reactivation Date: 02/24/2020

III. Provider practice location address

1611 NW 12 AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

1611 NW 12 AVENUE WEST WING ROOM279
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-8178
  • Fax:
Mailing address:
  • Phone: 305-585-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME160783
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: