Basic Information
| Provider Information | |||||||||
| NPI: | 1194380683 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUECK | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | SBCH, MEDICAL EDUCATION | ||||||||
| Address2: | 400 W PUEBLO STREET | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055697316 | ||||||||
| FaxNumber: | 8055697317 | ||||||||
| Practice Location | |||||||||
| Address1: | SBCH, MEDICAL EDUCATION | ||||||||
| Address2: | 400 W PUEBLO STREET | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055697316 | ||||||||
| FaxNumber: | 8055697317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2019 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME149484 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.