Provider Demographics
NPI:1720166150
Name:BUCAYCAY, ELEANOR FANGONIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:FANGONIL
Last Name:BUCAYCAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 DUDLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-2637
Mailing Address - Country:US
Mailing Address - Phone:916-561-7400
Mailing Address - Fax:
Practice Address - Street 1:5342 DUDLEY BLVD
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-2637
Practice Address - Country:US
Practice Address - Phone:916-561-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine