Provider Demographics
NPI:1952518540
Name:BRUCE B MCLUCAS M D A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BRUCE B MCLUCAS M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-208-2442
Mailing Address - Street 1:9663 SANTA MONICA BLVD # 1162
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-208-2442
Mailing Address - Fax:310-208-2621
Practice Address - Street 1:9675 BRIGHTON WAY STE 380
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5187
Practice Address - Country:US
Practice Address - Phone:866-479-1523
Practice Address - Fax:310-208-2621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG32182207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN