Healthcare Provider Details

I. General information

NPI: 1679815419
Provider Name (Legal Business Name): JAVIER DE LUCA-JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAVIER DE LUCA-WESTRATE

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

8901 ROCKVILLE PIKE
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-295-4000
  • Fax:
Mailing address:
  • Phone: 310-295-4000
  • Fax: 757-953-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101261786
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: