Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 14029 | AZ |
NPI | 1255453924 |
---|---|
Provider Name | Dr. Bernard-Dean Frank Marucci |
First Address | Pueblo, CO 81005-2175 |
Second Address | Pueblo, CO 81005-2175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 11/06/2014 |