Provider Demographics
NPI:1114925385
Name:BRICCA, CARL E (DO)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:E
Last Name:BRICCA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 SHRADER ST
Mailing Address - Street 2:SUITE 640
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1016
Mailing Address - Country:US
Mailing Address - Phone:415-752-0100
Mailing Address - Fax:415-752-7103
Practice Address - Street 1:1 SHRADER ST
Practice Address - Street 2:SUITE 640
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1016
Practice Address - Country:US
Practice Address - Phone:415-752-0100
Practice Address - Fax:415-752-7103
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E24902Medicare UPIN
00AX54030Medicare ID - Type Unspecified