Provider Demographics
NPI:1497442586
Name:BRUNCUSO HOLDINGS LLC
Entity Type:Organization
Organization Name:BRUNCUSO HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-847-2273
Mailing Address - Street 1:4425 E VILLA CASSANDRA WAY
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-9564
Mailing Address - Country:US
Mailing Address - Phone:480-847-2273
Mailing Address - Fax:
Practice Address - Street 1:4425 E VILLA CASSANDRA WAY
Practice Address - Street 2:
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-9564
Practice Address - Country:US
Practice Address - Phone:480-847-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty