Provider Demographics
NPI:1093876245
Name:BRUNO, YOVANA GRACIELA (MD)
Entity Type:Individual
Prefix:DR
First Name:YOVANA
Middle Name:GRACIELA
Last Name: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 1:1 VIA CERAMICA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-7012
Mailing Address - Country:US
Mailing Address - Phone:626-841-2574
Mailing Address - Fax:
Practice Address - Street 1:1750 HUNTINGTON DR STE D
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010
Practice Address - Country:US
Practice Address - Phone:626-930-1600
Practice Address - Fax:626-531-6920
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA800312080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A800310OtherMEDICAL PROVIDER NUMBER