Provider Demographics
NPI:1346468014
Name:BACCHI, CHRIS CARLUCCI (MD)
Entity type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:CARLUCCI
Last Name:BACCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:CIESIELSKI-CARLUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1030 SIR FRANCIS DRAKE BLVD SUITE #110
Mailing Address - Street 2:
Mailing Address - City:KENFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-461-1036
Mailing Address - Fax:415-461-1043
Practice Address - Street 1:1030 SIR FRANCIS DRAKE BLVD SUITE #110
Practice Address - Street 2:
Practice Address - City:KENFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-461-1036
Practice Address - Fax:415-461-1043
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60805207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine