# RICHARD L BUCCIGROSS MD A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841438413
- **Authorized official:** RICHARD LESLIE BUCCIGROSS M.D. (PRESIDENT)
- **Authorized official phone:** (858) 565-0900

## Contact information

- **Practice address:** 4550 KEARNY VILLA RD, SUITE 214, SAN DIEGO, CA 92123-1578
- **Practice address phone:** (858) 565-0900
- **Mailing address:** 4550 KEARNY VILLA RD, SUITE 214, SAN DIEGO, CA 92123-1578
- **Mailing address phone:** (858) 565-0900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | G31185 | CA | Yes |

## Other

- **Enumeration date:** 02/04/2009
- **Last updated:** 02/04/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00G311850 | — | CA |