Provider Demographics
NPI:1588078265
Name:DE LA CRUZ LUQUE, CELSO FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:CELSO
Middle Name:FERNANDO
Last Name:DE LA CRUZ LUQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 NW 9TH AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1310
Mailing Address - Country:US
Mailing Address - Phone:561-338-8884
Mailing Address - Fax:561-338-5230
Practice Address - Street 1:1599 NW 9TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1310
Practice Address - Country:US
Practice Address - Phone:561-338-8884
Practice Address - Fax:561-338-5230
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3149207RC0000X
FLTRN19764390200000X
FLME162053207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program