MEDICARE: BRUCE P. DECARLO, MD, 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	208100000X	Physical Medicine & Rehabilitation Physician	A304681	CA

General Provider Information

NPI Number	:	1801970173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE P. DECARLO, MD, INC.

Provider Business Mailing Address
First Line	:	373 IMPERIAL HWY
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-1040
Country	:	US
Telephone Number	:	714-441-1242
Fax Number	:	714-441-2449

Provider Business Practice Location Address
First Line	:	650 HOWE AVE
Second Line	:	SUITE 810
City	:	SACRAMENTO
State	:	CA
Zip	:	95825-4731
Country	:	US
Telephone Number	:	916-927-3046
Fax Number	:	916-927-3058

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	RICHARD SCHORK
Credential	:
Telephone Number	:	714-441-1242

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	08/22/2020

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