Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A105639 | CA |
N | 208600000X | Surgeon | A105639 | CA |
Y | 2086S0120X | Pediatric Surgery | 105639 | CA |
NPI | 1548381890 |
---|---|
Provider Name | Dr. Matias Bruzoni |
First Address | Newark, CA 94560-1197 |
Second Address | Palo Alto, CA 94304-1516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 05/04/2019 |