MEDICARE: FRED GALLUCCIO MD & ASSOC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1437267648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRED GALLUCCIO MD & ASSOC INC

Provider Business Mailing Address
First Line	:	901 DOVER DR
Second Line	:	STE 102
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5538
Country	:	US
Telephone Number	:	949-646-4865
Fax Number	:	949-646-7716

Provider Business Practice Location Address
First Line	:	901 DOVER DR
Second Line	:	STE 102
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5538
Country	:	US
Telephone Number	:	949-646-4865
Fax Number	:	949-646-7716

Authorized Official
Title or Position	:	OWNER
Name	:	FRED J GALLUCCIO
Credential	:	M.D.
Telephone Number	:	949-646-4865

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	08/22/2020

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