Healthcare Provider Details

I. General information

NPI: 1962792192
Provider Name (Legal Business Name): RICHARD ALAN BRUCKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 05/02/2025
Certification Date: 05/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 E EL SEGUNDO BLVD STE 210
EL SEGUNDO CA
90245-2743
US

IV. Provider business mailing address

2110 E EL SEGUNDO BLVD STE 210
EL SEGUNDO CA
90245-2743
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-8704
  • Fax: 310-893-0430
Mailing address:
  • Phone: 310-784-8704
  • Fax: 310-893-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA130777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: