Provider Demographics
NPI:1487835849
Name:MICHAEL J DE LUCA MD INCORPORATED
Entity Type:Organization
Organization Name:MICHAEL J DE LUCA MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DE LUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-591-7377
Mailing Address - Street 1:1745 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-1714
Mailing Address - Country:US
Mailing Address - Phone:562-591-7377
Mailing Address - Fax:562-591-7388
Practice Address - Street 1:1745 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-1714
Practice Address - Country:US
Practice Address - Phone:562-591-7377
Practice Address - Fax:562-591-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A289710Medicaid
CA00A289710Medicaid
W21903Medicare PIN
CAA28971Medicare PIN