Healthcare Provider Details

I. General information

NPI: 1629074976
Provider Name (Legal Business Name): BRUCE W KOVACS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12401 WHITTIER BLVD
WHITTIER CA
90602-1018
US

IV. Provider business mailing address

PO BOX 3389
SEAL BEACH CA
90740-2389
US

V. Phone/Fax

Practice location:
  • Phone: 562-693-7778
  • Fax: 562-693-3681
Mailing address:
  • Phone: 562-773-3155
  • Fax: 562-498-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG42117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: