Provider Demographics
NPI:1285624940
Name:FUSCALDO, FRANCISCO BRUNO (MD)
Entity type:Individual
Prefix:DR
First Name:FRANCISCO
Middle Name:BRUNO
Last Name:FUSCALDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FRANCISCO
Other - Middle Name:BRUNO
Other - Last Name:FUSCALDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2926 N. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90040
Mailing Address - Country:US
Mailing Address - Phone:323-221-1131
Mailing Address - Fax:323-221-3197
Practice Address - Street 1:2926 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031
Practice Address - Country:US
Practice Address - Phone:323-221-1131
Practice Address - Fax:323-221-3197
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW4578Medicare ID - Type UnspecifiedPROVIDER NUMBER