Provider Demographics
NPI:1407811250
Name:BUCCI, BRUNO (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:
Last Name:BUCCI
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 1:620 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-5716
Mailing Address - Country:US
Mailing Address - Phone:714-547-6485
Mailing Address - Fax:714-285-9466
Practice Address - Street 1:620 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5716
Practice Address - Country:US
Practice Address - Phone:714-547-6485
Practice Address - Fax:714-285-9466
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADA625ZMedicare UPIN