MEDICARE: DR. PATRICK CUCAROLA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	33310	CA

General Provider Information

NPI Number	:	1295105690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK CUCAROLA D.C.

Provider Business Mailing Address
First Line	:	1010 UNIVERSITY AVE
Second Line	:	SUITE C-203
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3398
Country	:	US
Telephone Number	:	619-295-9791
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 UNIVERSITY AVE
Second Line	:	SUITE C-203
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3398
Country	:	US
Telephone Number	:	619-295-9791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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