Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 65598 | CT |
NPI | 1023496122 |
---|---|
Provider Name | Bruno Cardoso |
First Address | New Haven, CT 06519-1369 |
Second Address | New Haven, CT 06519-1369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 20/10/2020 |