Provider Demographics
NPI:1790742062
Name:BECK, LUNA BELLA (MD)
Entity Type:Individual
Prefix:
First Name:LUNA
Middle Name:BELLA
Last Name:BECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17820 SE 109TH AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8968
Mailing Address - Country:US
Mailing Address - Phone:352-307-7940
Mailing Address - Fax:352-307-7941
Practice Address - Street 1:17820 SE 109TH AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8968
Practice Address - Country:US
Practice Address - Phone:352-307-7940
Practice Address - Fax:352-307-7941
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I03494Medicare UPIN
43178XMedicare ID - Type Unspecified