Provider Demographics
NPI:1730193681
Name:RUOCCO, DRUCILLA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:DRUCILLA
Middle Name:ANN
Last Name:RUOCCO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 CAMINO DEL RIO S STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3735
Mailing Address - Country:US
Mailing Address - Phone:619-283-2184
Mailing Address - Fax:619-285-1938
Practice Address - Street 1:2423 CAMINO DEL RIO S STE 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3735
Practice Address - Country:US
Practice Address - Phone:619-283-2184
Practice Address - Fax:619-285-1938
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15358103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPO8415Medicare UPIN