Provider Demographics
NPI:1962792192
Name:BRUCKER, RICHARD ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:BRUCKER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E EL SEGUNDO BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2743
Mailing Address - Country:US
Mailing Address - Phone:310-784-8704
Mailing Address - Fax:310-893-0430
Practice Address - Street 1:2110 E EL SEGUNDO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2743
Practice Address - Country:US
Practice Address - Phone:310-784-8704
Practice Address - Fax:310-893-0430
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130777208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics