Individual
MARK C BOCCHICCHIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FACC
Contact information
Practice address
1941 JOHNSON AVE STE 101, SAN LUIS OBISPO, CA 93401-4154
(805) 782-8844
(805) 782-8859
Mailing address
1941 JOHNSON AVE, SUITE 101, SAN LUIS OBISPO, CA 93401-4140
(805) 782-8844
(805) 782-8859
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
A63687
CA
207RI0011X
Interventional Cardiology Physician
Primary
A63687
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A6368700
—
CA
01
—
P00187560
RR MEDI-CARE
CA
01
—
ZZZ28458Z
BLUE SHIELD
CA
Enumeration date
03/27/2006
Last updated
07/21/2022
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