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General NPI Number Information
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NPI Number | 1801948302
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Entity Type | Individual
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Provider Name | NANCY BUCCIARELLI M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 24401 CALLE DE LA LOUISA SUITE 200
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3623
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Country | US
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Telephone | 949-464-0470
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Fax | 949-464-0720
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Provider Business Mailing Address
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Address Line | 668 N COAST HWY SUITE 1339
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City | LAGUNA BEACH
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State | CA
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Zip | 92651-1513
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Country | US
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Telephone | 949-464-0470
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Fax | 949-464-0720
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G59322
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License Number State | CA
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