Provider Demographics
NPI:1922524495
Name:BRUCE, RICHARD DEEN-FRANCIS (PA-C, MPAP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DEEN-FRANCIS
Last Name:BRUCE
Suffix:
Gender:M
Credentials:PA-C, MPAP
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1001 AVENIDA PICO STE C-125
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6957
Mailing Address - Country:US
Mailing Address - Phone:910-322-7257
Mailing Address - Fax:
Practice Address - Street 1:65 AVENIDA MERIDA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-3911
Practice Address - Country:US
Practice Address - Phone:910-322-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134485OtherNCCPA