Provider Demographics
NPI:1902815822
Name:MORICCA, ROBERT BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRUCE
Last Name:MORICCA
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 1:320 SUPERIOR AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2741
Mailing Address - Country:US
Mailing Address - Phone:949-642-6200
Mailing Address - Fax:949-642-9359
Practice Address - Street 1:320 SUPERIOR AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2741
Practice Address - Country:US
Practice Address - Phone:949-642-6200
Practice Address - Fax:949-642-9359
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49411207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G49411OtherLICENSE
CAGR0077190Medicaid
CAGR0077190Medicaid
A92901Medicare UPIN
CAGR0077190Medicaid