Provider Demographics
NPI:1578674255
Name:DULANTO, LUIGI ALBERTO (MD)
Entity type:Individual
Prefix:
First Name:LUIGI
Middle Name:ALBERTO
Last Name:DULANTO
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 1:30 RITO GUICU
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4301
Mailing Address - Country:US
Mailing Address - Phone:505-718-6419
Mailing Address - Fax:
Practice Address - Street 1:30 RITO GUICU
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4301
Practice Address - Country:US
Practice Address - Phone:505-718-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA847342084P0800X
NM2002-04512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59206837Medicaid
NM59206837Medicaid