Organization
CHARLENE T. DELUCA, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLENE T. DELUCA MD (PRESIDENT)
(239) 537-9037
Entity
Organization
Contact information
Practice address
6101 PINE RIDGE RD, NAPLES, FL 34119-3900
(239) 537-9037
Mailing address
6017 PINE RIDGE RD, NAPLES, FL 34119-3956
(239) 537-9037
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
ME94900
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002507100
—
FL
05
—
002753800
—
FL
01
—
56401
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
01
—
Y04QU
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
Enumeration date
03/08/2012
Last updated
03/08/2012
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