Provider Demographics
NPI:1760689426
Name:YOVANA BRUNO PEDIATRIC CARE INC.
Entity type:Organization
Organization Name:YOVANA BRUNO PEDIATRIC CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOVANA
Authorized Official - Middle Name:GRACIELA
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-200-7737
Mailing Address - Street 1:3553 CAMINO MIRA COSTA STE D
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3512
Mailing Address - Country:US
Mailing Address - Phone:949-200-7737
Mailing Address - Fax:949-336-1949
Practice Address - Street 1:3553 CAMINO MIRA COSTA STE D
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3512
Practice Address - Country:US
Practice Address - Phone:949-200-7737
Practice Address - Fax:949-336-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0104850OtherMEDICAL