Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0700X | Adult Development & Aging Psychologist | PSY 26003 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY 26003 | CA |
Y | 103G00000X | Clinical Psychologist | PSY 26003 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 26003 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY 26003 | CA |
N | 103TF0000X | Family Psychologist | PSY 26003 | CA |
N | 103TF0200X | Forensic Psychologist | PSY 26003 | CA |
N | 103TP2701X | Group Psychotherapist | PSY 26003 | CA |
NPI | 1063539575 |
---|---|
Provider Name | Dr. Daniel Ernesto Bruzzone |
First Address | Torrance, CA 90505-5388 |
Second Address | Torrance, CA 90505-5388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 02/02/2018 |