Provider Demographics
NPI:1821018029
Name:BRICCETTI, ALBERT B (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:B
Last Name:BRICCETTI
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 1:4170 SOUTH CLUB DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906
Mailing Address - Country:US
Mailing Address - Phone:719-302-5129
Mailing Address - Fax:818-933-0555
Practice Address - Street 1:732 CARNEGIE DR
Practice Address - Street 2:REGAL MEDICAL GROUP - SUITE 125
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3500
Practice Address - Country:US
Practice Address - Phone:951-314-7304
Practice Address - Fax:818-933-0555
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23105207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F77657Medicare UPIN