MEDICARE: BROOKE DEL BOCCIO

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	363LC0200X	Critical Care Medicine Nurse Practitioner	10023099	OR
2	363LA2100X	Acute Care Nurse Practitioner	95030903	CA

General Provider Information

NPI Number	:	1366277857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE DEL BOCCIO

Provider Business Mailing Address
First Line	:	6511 HALIFAX DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6511 HALIFAX DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2603
Country	:	US
Telephone Number	:	949-680-6279
Fax Number	:

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

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/05/2024

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Directions to “ BROOKE DEL BOCCIO ” Practice Location

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