Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A119651 | CA |
Y | 2080P0203X | Pediatric Critical Care Doctor | A119651 | CA |
NPI | 1225340755 |
---|---|
Provider Name | Dr. Diana Bruno |
First Address | Los Angeles, CA 90010-2804 |
Second Address | Los Angeles, CA 90027-6062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2010 |
Last Update Date | 30/11/2021 |