MEDICARE: DR. MICHAEL IOCCA D.O.

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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	20A6072	CA

General Provider Information

NPI Number	:	1629133079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL IOCCA D.O.

Provider Business Mailing Address
First Line	:	7677 OAKPORT ST STE 1200
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94621-1975
Country	:	US
Telephone Number	:	510-437-4893
Fax Number	:	510-379-7440

Provider Business Practice Location Address
First Line	:	1411 E 31ST ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-1092
Country	:	US
Telephone Number	:	510-437-4893
Fax Number	:	510-379-7440

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	09/16/2019

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