Healthcare Provider Details

I. General information

NPI: 1982252334
Provider Name (Legal Business Name): DANIEL RICHARD CIOCCA AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9660 HAVEN AVE STE 203
RANCHO CUCAMONGA CA
91730-5897
US

IV. Provider business mailing address

7770 GARNET ST
RANCHO CUCAMONGA CA
91730-2109
US

V. Phone/Fax

Practice location:
  • Phone: 909-368-0566
  • Fax:
Mailing address:
  • Phone: 909-638-3985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95012532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: