Healthcare Provider Details

I. General information

NPI: 1457601627
Provider Name (Legal Business Name): NATOSHA MARIA DELUCCE LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 DIVISADERO ST
SAN FRANCISCO CA
94115-3011
US

IV. Provider business mailing address

529 ANGUS W.
SAN BRUNO CA
94066
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7878
  • Fax:
Mailing address:
  • Phone: 650-576-4235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 193582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: