Provider Demographics
NPI:1609160472
Name:DELUCA, VALERIE KAI (DO)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:KAI
Last Name:DELUCA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WEST PLUMMER
Mailing Address - Street 2:
Mailing Address - City:EASTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:76448
Mailing Address - Country:US
Mailing Address - Phone:254-629-3393
Mailing Address - Fax:254-629-2851
Practice Address - Street 1:500 WEST PLUMMER
Practice Address - Street 2:
Practice Address - City:EASTLAND
Practice Address - State:TX
Practice Address - Zip Code:76448
Practice Address - Country:US
Practice Address - Phone:254-629-3393
Practice Address - Fax:254-629-2851
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5616207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339802601Medicaid
TX283061401OtherTPI
TX283061401OtherTPI