Healthcare Provider Details

I. General information

NPI: 1558520619
Provider Name (Legal Business Name): FRANK A DELUCIA MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 S OLD DIXIE HWY 206
JUPITER FL
33458-7202
US

IV. Provider business mailing address

1002 S OLD DIXIE HWY 206
JUPITER FL
33458-7202
US

V. Phone/Fax

Practice location:
  • Phone: 561-747-6300
  • Fax: 561-747-6301
Mailing address:
  • Phone: 561-747-6300
  • Fax: 561-747-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0800008193
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberME0037332
License Number StateFL

VIII. Authorized Official

Name: FRANK A DELUCIA
Title or Position: OWNER
Credential: MD
Phone: 561-747-6300