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General NPI Number Information
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NPI Number | 1689339376
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Entity Type | Individual
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Provider Name | MATTHEW J DELUCA CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/08/2021
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 400 W 16TH ST, PUEBLO
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City | PUEBLO
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State | CO
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Zip | 81003
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Country | US
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Telephone | 719-584-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 15825 E SUNFLOWER DR
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-3636
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Country | US
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Telephone |
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APN.0997148-CRNA
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 328950
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License Number State | AZ
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