MEDICARE: MANNY DELUCCA 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	208000000X	Pediatrics Physician	27388	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	12-00497	OTHER	UNITED HEALTHCARE
2	210610	OTHER	MAYO
3	1Z9385	OTHER	HEALTHNET
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1229050	OTHER	FIRST HEALTH
7	5225829	OTHER	CCN

General Provider Information

NPI Number	:	1740280882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANNY DELUCCA M.D.

Provider Business Mailing Address
First Line	:	26224 N TATUM BLVD
Second Line	:	SUITE 1
City	:	PHOENIX
State	:	AZ
Zip	:	85050-7500
Country	:	US
Telephone Number	:	480-563-1111
Fax Number	:	480-563-3044

Provider Business Practice Location Address
First Line	:	26224 N TATUM BLVD
Second Line	:	SUITE 1
City	:	PHOENIX
State	:	AZ
Zip	:	85050-7500
Country	:	US
Telephone Number	:	480-563-1111
Fax Number	:	480-563-3044

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/28/2008

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Directions to “ MANNY DELUCCA M.D.” Practice Location

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