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General NPI Number Information
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NPI Number | 1588078265
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Entity Type | Individual
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Provider Name | CELSO FERNANDO DE LA CRUZ LUQUE MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 10/06/2023
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Provider Practice Location Address
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Address Line | 1599 NW 9TH AVE STE 203
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City | BOCA RATON
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State | FL
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Zip | 33486-1310
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Country | US
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Telephone | 561-338-8884
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Fax | 561-338-5230
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Provider Business Mailing Address
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Address Line | 1599 NW 9TH AVE STE 203
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City | BOCA RATON
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State | FL
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Zip | 33486-1310
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Country | US
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Telephone | 561-338-8884
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Fax | 561-338-5230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | S3149
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | TRN19764
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME162053
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License Number State | FL
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