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General NPI Number Information
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NPI Number | 1184938334
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Entity Type | Individual
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Provider Name | JOSEPH JOHN FANUCCHI MD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2010
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Last Update Date | 07/29/2010
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Provider Practice Location Address
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Address Line | 943 INA DR
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City | ALAMO
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State | CA
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Zip | 94507-1349
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Country | US
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Telephone | 925-820-7758
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Fax |
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Provider Business Mailing Address
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Address Line | 943 INA DR
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City | ALAMO
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State | CA
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Zip | 94507-1349
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Country | US
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Telephone | 925-820-7758
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Fax |
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | G38864
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License Number State | CA
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