Healthcare Provider Details

I. General information

NPI: 1710541859
Provider Name (Legal Business Name): SAMANTHA DELUCA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 CALIFORNIA ST STE 1400
SAN FRANCISCO CA
94104-2116
US

IV. Provider business mailing address

425 CALIFORNIA ST
SAN FRANCISCO CA
94104-2102
US

V. Phone/Fax

Practice location:
  • Phone: 831-484-7713
  • Fax: 650-360-0447
Mailing address:
  • Phone: 855-527-1850
  • Fax: 650-360-0447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0075568
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39062
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: