Provider Demographics
NPI:1609334390
Name:SOUTHSIDE PEDIATRICS. A.P.M.C.
Entity Type:Organization
Organization Name:SOUTHSIDE PEDIATRICS. A.P.M.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-839-2238
Mailing Address - Street 1:811 ALBERTSON PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5256
Mailing Address - Country:US
Mailing Address - Phone:337-839-2238
Mailing Address - Fax:
Practice Address - Street 1:811 ALBERTSON PKWY STE A
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-5256
Practice Address - Country:US
Practice Address - Phone:337-839-2238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty