Healthcare Provider Details

I. General information

NPI: 1922935048
Provider Name (Legal Business Name): DANIELLE MARIE BUCCOLA MS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1690 W SHAW AVE STE 220
FRESNO CA
93711-3519
US

IV. Provider business mailing address

365 N EMERALD DR APT 22
VISTA CA
92083-6187
US

V. Phone/Fax

Practice location:
  • Phone: 857-800-1127
  • Fax:
Mailing address:
  • Phone: 714-401-8604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86342727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: