MEDICARE: DR. MARK A DELUCCHI PH.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	103T00000X	Psychologist	PSY24311	CA

General Provider Information

NPI Number	:	1710266994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK A DELUCCHI PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 22423
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-0423
Country	:	US
Telephone Number	:	415-335-5118
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 5TH ST
Second Line	:	SUITE 309
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94107-1536
Country	:	US
Telephone Number	:	415-335-5118
Fax Number	:

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

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	08/05/2011

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