MEDICARE: MONICA BRUCE D.D.S.

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	1223G0001X	General Practice Dentistry	42527	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D42527-01	OTHER	CA	MEDI-CAL ID#

General Provider Information

NPI Number	:	1508880402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA BRUCE D.D.S.

Provider Business Mailing Address
First Line	:	3756 SANTA ROSALIA DR STE 204
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3756 SANTA ROSALIA DR STE 204
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-3619
Country	:	US
Telephone Number	:	323-293-7225
Fax Number	:

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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Directions to “ MONICA BRUCE D.D.S.” Practice Location

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