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General NPI Number Information
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NPI Number | 1225302201
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Entity Type | Organization
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Legal Business Name | CHARLENE T. DELUCA, MD, PA
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Dates
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Enumeration Date | 03/08/2012
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Last Update Date | 03/08/2012
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Provider Practice Location Address
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Address Line | 6101 PINE RIDGE RD
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City | NAPLES
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State | FL
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Zip | 34119-3900
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Country | US
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Telephone | 239-537-9037
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Fax |
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Provider Business Mailing Address
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Address Line | 6017 PINE RIDGE RD
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City | NAPLES
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State | FL
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Zip | 34119-3956
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Country | US
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Telephone | 239-537-9037
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLENE T. DELUCA
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Credential | MD
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Telephone | 239-537-9037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME94900
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License Number State | FL
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