MEDICARE: DR. DRUCILLA ANN RUOCCO PH.D.

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	103T00000X	Psychologist	PSY15358	CA

General Provider Information

NPI Number	:	1730193681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DRUCILLA ANN RUOCCO PH.D.

Provider Business Mailing Address
First Line	:	2423 CAMINO DEL RIO S STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3735
Country	:	US
Telephone Number	:	619-283-2184
Fax Number	:	619-285-1938

Provider Business Practice Location Address
First Line	:	2423 CAMINO DEL RIO S STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3735
Country	:	US
Telephone Number	:	619-283-2184
Fax Number	:	619-285-1938

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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