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General NPI Number Information
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NPI Number | 1184628000
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Entity Type | Individual
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Provider Name | GREGORY MICHAEL BRICCA MD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 9269 SIERRA COLLEGE BLVD
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City | ROSEVILLE
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State | CA
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Zip | 95661
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Country | US
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Telephone | 916-772-1585
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Fax | 916-772-5685
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Provider Business Mailing Address
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Address Line | 9269 SIERRA COLLEGE BLVD
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City | ROSEVILLE
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State | CA
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Zip | 95661
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Country | US
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Telephone | 916-772-1585
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Fax | 916-772-5685
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A70396
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A70396
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License Number State | CA
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