Healthcare Provider Details

I. General information

NPI: 1932330438
Provider Name (Legal Business Name): MRS. LUISA DELUCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10557 JUNIPER AVE
FONTANA CA
92337-7589
US

IV. Provider business mailing address

PO BOX 8170
LA VERNE CA
91750-8170
US

V. Phone/Fax

Practice location:
  • Phone: 310-600-8951
  • Fax: 619-330-4985
Mailing address:
  • Phone: 310-600-8951
  • Fax: 619-330-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: