Healthcare Provider Details

I. General information

NPI: 1417069105
Provider Name (Legal Business Name): SAMUEL L BRUCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST STE #511
PASADENA CA
91105-3023
US

IV. Provider business mailing address

PO BOX 50766
PASADENA CA
91115-0766
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-0360
  • Fax: 626-796-0634
Mailing address:
  • Phone: 626-796-0360
  • Fax: 626-796-0634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG292231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: