Healthcare Provider Details

I. General information

NPI: 1265303077
Provider Name (Legal Business Name): ALEXANDRA DELUCA MS, C-IAYT, ERYT-500
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 OAKWOOD BLVD STE 163
HOLLYWOOD FL
33020-1961
US

IV. Provider business mailing address

2517 N 28TH AVE
HOLLYWOOD FL
33020-1815
US

V. Phone/Fax

Practice location:
  • Phone: 954-663-2692
  • Fax:
Mailing address:
  • Phone: 954-663-2692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number78543601
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number78543601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: