Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 13149 | CA |
N | 103TC0700X | Clinical Psychologist | 13149 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 13149 | CA |
NPI | 1023233202 |
---|---|
Provider Name | Dr. Jeffrey Joseph Bruno |
First Address | Pacifica, CA 94044-2700 |
Second Address | Pacifica, CA 94044-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 08/07/2007 |