Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1194352633 |
---|---|
Provider Name | Nicole Imelda Bruno |
First Address | Visalia, CA 93277-8307 |
Second Address | Visalia, CA 93277-8307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2020 |
Last Update Date | 28/05/2021 |