Basic Information
| Provider Information | |||||||||
| NPI: | 1366448854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRUCK | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 591 N 13TH AVE | ||||||||
| Address2: | STE 3 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099855885 | ||||||||
| FaxNumber: | 9099203379 | ||||||||
| Practice Location | |||||||||
| Address1: | 591 N 13TH AVE | ||||||||
| Address2: | STE 3 | ||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917864968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099855885 | ||||||||
| FaxNumber: | 9099203379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2005 | ||||||||
| LastUpdateDate: | 07/31/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G30560 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | G30560 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.