MEDICARE: DR. LAURA A DE LUCA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME94833	FL
2	2084P0800X	Psychiatry Physician	200415	LA
3	2084P0800X	Psychiatry Physician	239082	NY

General Provider Information

NPI Number	:	1275552689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA A DE LUCA M.D.

Provider Business Mailing Address
First Line	:	11903 SOUTHERN BLVD
Second Line	:	SUITE 104
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-333-8884
Fax Number	:	561-333-2122

Provider Business Practice Location Address
First Line	:	11903 SOUTHERN BLVD
Second Line	:	SUITE 104
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-333-8884
Fax Number	:	561-333-2122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	05/24/2011

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