Healthcare Provider Details

I. General information

NPI: 1790742062
Provider Name (Legal Business Name): LUNA BELLA BECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17820 SE 109TH AVE SUITE 107
SUMMERFIELD FL
34491-8968
US

IV. Provider business mailing address

17820 SE 109TH AVE SUITE 107
SUMMERFIELD FL
34491-8968
US

V. Phone/Fax

Practice location:
  • Phone: 352-307-7940
  • Fax: 352-307-7941
Mailing address:
  • Phone: 352-307-7940
  • Fax: 352-307-7941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME88111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: