Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A80031 | CA |
N | 2080A0000X | Adolescent Medicine | A80031 | CA |
NPI | 1093876245 |
---|---|
Provider Name | Dr. Yovana Graciela Bruno |
First Address | San Clemente, CA 92673-7012 |
Second Address | Duarte, CA 91010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A800310 | MEDICAL PROVIDER NUMBER (01) | CA |