Provider Demographics
NPI:1073726444
Name:RODRIGUEZ-BRUNO, KRISTA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MICHELLE
Last Name:RODRIGUEZ-BRUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9834 GENESEE AVE STE 416
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1264
Mailing Address - Country:US
Mailing Address - Phone:858-458-1287
Mailing Address - Fax:858-452-9160
Practice Address - Street 1:9834 GENESEE AVE STE 416
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1264
Practice Address - Country:US
Practice Address - Phone:858-458-1287
Practice Address - Fax:858-452-9160
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD70424207Y00000X
CAA99037207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD037375300Medicaid
MD194030ZAK8Medicare PIN
MD037375300Medicaid