Provider Demographics
NPI:1437303013
Name:DELUCA, ASHLEY B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:B
Last Name:DELUCA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ASHLEY
Other - Middle Name:B
Other - Last Name:MCCOMBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1501 WEST 24TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364
Mailing Address - Country:US
Mailing Address - Phone:928-726-6335
Mailing Address - Fax:928-726-6338
Practice Address - Street 1:1501 WEST 24TH ST.
Practice Address - Street 2:SUITE C
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-726-6335
Practice Address - Fax:928-726-6338
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ323925OtherHEALTHNET
AZ3Z3925OtherHEALTH NET
AZ406052Medicaid
AZ2136734Medicare UPIN
AZ3Z3925OtherHEALTH NET
AZP00842031Medicare PIN