Paul Joseph Fanucchi, NP

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

AP108274 Issued in TX

Practice address

Marianist Residence
520 Fondham
San Antonio, TX 78228-4821

Phone

(210) 434-4157

Fax

(210) 433-6005

NPI assigned

Jan 18, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642464000000",
    "number": "1003567447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MARIANIST RESIDENCE",
            "address_2": "520 FONDHAM",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782284821",
            "telephone_number": "210-434-4157",
            "fax_number": "210-433-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "MARIANIST RESIDENCE",
            "address_2": "520 FONDHAM",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782284821",
            "telephone_number": "210-434-4157",
            "fax_number": "210-433-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANUCCHI",
        "first_name": "PAUL",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-01-18",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "TX",
            "license": "AP108274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in San Antonio, TX
• Geriatric Medicine (Internal Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.