MEDICARE: DR. FULGENCIO BRAGANZA DEL CASTILLO III M.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	208000000X	Pediatrics Physician	C177174	CA
2	2080P0006X	Developmental - Behavioral Pediatrics Physician	C177174	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C177174	OTHER	CA	MEDICAL BOARD OF CALIFORNIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881692291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FULGENCIO BRAGANZA DEL CASTILLO III M.D.

Provider Business Mailing Address
First Line	:	710 LAWRENCE EXPY DEPT 190
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5173
Country	:	US
Telephone Number	:	408-851-1240
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 LAWRENCE EXPY DEPT 190
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5173
Country	:	US
Telephone Number	:	408-851-1240
Fax Number	:

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	07/27/2022

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