Provider Demographics
NPI:1538153135
Name:BRUNO, CARLOS A (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:BRUNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:811 ALBERTSONS PARKWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518
Mailing Address - Country:US
Mailing Address - Phone:337-839-2265
Mailing Address - Fax:337-839-2213
Practice Address - Street 1:811 ALBERTSON PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-5256
Practice Address - Country:US
Practice Address - Phone:337-839-2265
Practice Address - Fax:337-839-2213
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA022562208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1498882Medicaid
LA1538153135OtherNPI
LA1538153135OtherNPI