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General NPI Number Information
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NPI Number | 1821018029
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Entity Type | Individual
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Provider Name | ALBERT B BRICCETTI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 732 CARNEGIE DR REGAL MEDICAL GROUP - SUITE 125
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3500
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Country | US
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Telephone | 951-314-7304
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Fax | 818-933-0555
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Provider Business Mailing Address
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Address Line | 4170 SOUTH CLUB DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906
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Country | US
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Telephone | 719-302-5129
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Fax | 818-933-0555
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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 | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | G23105
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License Number State | CA
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