MEDICARE: AMENA MARIE DELUCA MD

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	207ND0101X	MOHS-Micrographic Surgery Physician	49719	AZ

General Provider Information

NPI Number	:	1972766921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMENA MARIE DELUCA MD

Provider Business Mailing Address
First Line	:	4512 N 40TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3604
Country	:	US
Telephone Number	:	602-954-7546
Fax Number	:

Provider Business Practice Location Address
First Line	:	4512 N 40TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-3604
Country	:	US
Telephone Number	:	602-954-7546
Fax Number	:

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

Provider Enumeration Date	:	07/09/2008
Last Update Date	:	02/27/2015

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