Provider Demographics
NPI:1275260887
Name:BRUNO, JESSICA (CNS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BRUNO
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 ACACIA AVE APT C
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-3284
Mailing Address - Country:US
Mailing Address - Phone:949-573-3688
Mailing Address - Fax:
Practice Address - Street 1:318 ACACIA AVE APT C
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-3284
Practice Address - Country:US
Practice Address - Phone:949-573-3688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered