Provider Demographics
NPI:1407976491
Name:BRUNO, JOSE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:BRUNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6726 HANLEY RD
Mailing Address - Street 2:URB. ARBOLADA
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-4739
Mailing Address - Country:US
Mailing Address - Phone:813-284-7903
Mailing Address - Fax:
Practice Address - Street 1:G1 CALLE ALMACIGO
Practice Address - Street 2:URB. ARBOLADA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-1311
Practice Address - Country:US
Practice Address - Phone:787-745-4899
Practice Address - Fax:787-745-4899
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11,242207Q00000X
FLACN581261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine