Healthcare Provider Details

I. General information

NPI: 1770928558
Provider Name (Legal Business Name): ALEXIS B DE LUCCA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS B HANSEN

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 SE MILWAUKIE AVE
PORTLAND OR
97202-5418
US

IV. Provider business mailing address

6327 SE MILWAUKIE AVE
PORTLAND OR
97202-5418
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-4988
  • Fax: 833-428-4937
Mailing address:
  • Phone: 503-659-4988
  • Fax: 833-428-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD175758
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: