Individual
NANCY BUCCIARELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
24401 CALLE DE LA LOUISA, SUITE 200, LAGUNA HILLS, CA 92653-3623
(949) 464-0470
(949) 464-0720
Mailing address
668 N COAST HWY, SUITE 1339, LAGUNA BEACH, CA 92651-1513
(949) 464-0470
(949) 464-0720
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G59322
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB225510
MEDICARE INDIVIDUAL PTAN
CA
01
—
CB22951
MEDICARE GROUP PTAN
CA
Enumeration date
01/17/2007
Last updated
07/26/2016
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