De Lucca, Alexis B

De Lucca, Alexis B is an individual health care provider with primary practice located at 2020 Se 182Nd Avenue , Gresham OR 97030. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. De Lucca, Alexis B can be contacted via phone (503) 988-5400.

Contact Information

Primary practice address
2020 Se 182Nd Avenue Gresham OR 97030
Phone: (503) 988-5400
Fax: (503) 988-5668
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD175758 Oregon
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X Oregon

Profile Details

NPI number 1770928558
LBN Legal business name De Lucca, Alexis B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 7th, 2013
Last updated Dec 19th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770928558 NPPES
Oregon MEDICAID 096511
Oregon MEDICAID 022959

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