Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC15102 | CA |
N | 111NN0400X | Neurology | DC322 | HI |
NPI | 1942420377 |
---|---|
Provider Name | Dr. Richard P. Muccillo |
First Address | Carlsbad, CA 92008-1808 |
Second Address | Carlsbad, CA 92008-1808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 20/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T83234 | (02) | CA |