Provider Demographics
NPI:1891730974
Name:LUNA, BLANCA CRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:CRISTINA
Last Name:LUNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1410 LPGA BLVD
Mailing Address - Street 2:SUITE 136
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5115
Mailing Address - Country:US
Mailing Address - Phone:386-274-4750
Mailing Address - Fax:386-274-2499
Practice Address - Street 1:1410 LPGA BLVD
Practice Address - Street 2:SUITE 136
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5115
Practice Address - Country:US
Practice Address - Phone:386-274-4750
Practice Address - Fax:386-274-2499
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME069660207R00000X
FLME69660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008194OtherFHCP
FL28295OtherBCBS
FL261635100Medicaid
FL5910274OtherAETNA
FLHEASEOther206630
FL0401213OtherUHC
FL080134191OtherRAILROAD MC
FL9694592OtherGHI
FL4753172OtherCIGNA
FL4753172OtherCIGNA
FLF13487Medicare UPIN
FL261635100Medicaid