Provider Demographics
NPI:1790875011
Name:BRUCAL, CELERINO BACAL (MD)
Entity Type:Individual
Prefix:
First Name:CELERINO
Middle Name:BACAL
Last Name:BRUCAL
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 1:8524 TUJUNGA VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-2358
Mailing Address - Country:US
Mailing Address - Phone:818-353-1533
Mailing Address - Fax:818-353-1533
Practice Address - Street 1:8524 TUJUNGA VALLEY ST
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-2358
Practice Address - Country:US
Practice Address - Phone:818-353-1533
Practice Address - Fax:818-353-1533
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A402080Medicaid
CAA40208AMedicare ID - Type Unspecified
CA00A402080Medicaid