Healthcare Provider Details

I. General information

NPI: 1295963155
Provider Name (Legal Business Name): HECTOR DELUCCA JIMENEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 09/29/2024
Certification Date: 09/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CALLE GAUTIER BENITEZ STE 400
CAGUAS PR
00725-5527
US

IV. Provider business mailing address

201 CALLE GAUTIER BENITEZ STE 400
CAGUAS PR
00725-5527
US

V. Phone/Fax

Practice location:
  • Phone: 787-957-8282
  • Fax: 787-665-1165
Mailing address:
  • Phone: 787-957-8282
  • Fax: 787-665-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20619
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number20619
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: