Healthcare Provider Details

I. General information

NPI: 1114090529
Provider Name (Legal Business Name): GINA M DELUCCA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MUIR RD
MARTINEZ CA
94553-4614
US

IV. Provider business mailing address

1824 MENESINI PL
MARTINEZ CA
94553-8615
US

V. Phone/Fax

Practice location:
  • Phone: 925-372-1208
  • Fax:
Mailing address:
  • Phone: 925-207-8196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number51223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: