Healthcare Provider Details

I. General information

NPI: 1215907597
Provider Name (Legal Business Name): JAMES J MUCCIARONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WOMBLE ST BLDG 3601
SAN DIEGO CA
92136-0001
US

IV. Provider business mailing address

948 E AVE
CORONADO CA
92118-2544
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-3563
  • Fax:
Mailing address:
  • Phone: 619-437-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101238550
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: