MEDICARE: LUNA BELLA BECK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME88111	FL

General Provider Information

NPI Number	:	1790742062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUNA BELLA BECK M.D.

Provider Business Mailing Address
First Line	:	17820 SE 109TH AVE
Second Line	:	SUITE 107
City	:	SUMMERFIELD
State	:	FL
Zip	:	34491-8968
Country	:	US
Telephone Number	:	352-307-7940
Fax Number	:	352-307-7941

Provider Business Practice Location Address
First Line	:	17820 SE 109TH AVE
Second Line	:	SUITE 107
City	:	SUMMERFIELD
State	:	FL
Zip	:	34491-8968
Country	:	US
Telephone Number	:	352-307-7940
Fax Number	:	352-307-7941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	05/29/2009

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