Provider Demographics
NPI:1689679458
Name:BOCCARDO, HUMBERTO JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:JOSE
Last Name:BOCCARDO
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 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:STE 14B
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4339
Mailing Address - Country:US
Mailing Address - Phone:949-951-7808
Mailing Address - Fax:949-951-4831
Practice Address - Street 1:24953 PASEO DE VALENCIA
Practice Address - Street 2:STE 14B
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4339
Practice Address - Country:US
Practice Address - Phone:949-951-7808
Practice Address - Fax:949-951-4831
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A357470Medicaid
A35747Medicare ID - Type Unspecified