1235152919 NPI number — DR. MARY L. DE LUCA M.D.

Table of content: (NPI 1306659578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235152919 NPI number — DR. MARY L. DE LUCA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LUCA
Provider First Name:
MARY
Provider Middle Name:
L.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235152919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 INDIAN SCHOOL RD NE
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-3816
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-830-1100
Provider Business Mailing Address Fax Number:
505-291-8441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 INDIAN SCHOOL RD NE
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87110-3816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-830-1100
Provider Business Practice Location Address Fax Number:
505-291-8441
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  97-217 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X , with the licence number: 97-217 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S7135 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com