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NPI Code Detail

MEDICARE: BELLA LUNA CLC

MEDICARE: BELLA LUNA CLC
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
1174N00000XLactation Consultant (Non-RN)NM
2374J00000XDoula364756NM

General Provider Information

NPI Number : 1952286288
Entity Type Code : Individual
Provider Name (Legal Business Name) : BELLA LUNA CLC
Provider Business Mailing Address
First Line : 3616 MOONLIGHT AVE
Second Line :
City : EL PASO
State : TX
Zip : 79904-1113
Country : US
Telephone Number : 915-216-3644
Fax Number :
Provider Business Practice Location Address
First Line : 8500 DYER ST STE 34
Second Line :
City : EL PASO
State : TX
Zip : 79904-2800
Country : US
Telephone Number : 915-216-3644
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2025
Last Update Date : 02/05/2026

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