Provider Demographics
NPI:1770539090
Name:DELUCA, PAULA ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:ANN
Last Name:DELUCA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10075 JOG ROAD
Mailing Address - Street 2:STE 208
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437
Mailing Address - Country:US
Mailing Address - Phone:561-734-4867
Mailing Address - Fax:
Practice Address - Street 1:10075 S JOG RD
Practice Address - Street 2:STE 208
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3535
Practice Address - Country:US
Practice Address - Phone:561-734-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3066213ES0103X
MIPO001686213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM41960Medicare ID - Type Unspecified
MIU64728Medicare UPIN