Provider Demographics
NPI:1710009287
Name:CHUMPITAZI, BRUNO PEDRO (MD)
Entity Type:Individual
Prefix:
First Name:BRUNO
Middle Name:PEDRO
Last Name:CHUMPITAZI
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 1:6621 FANNIN ST
Mailing Address - Street 2:CC 1010.00
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2303
Mailing Address - Country:US
Mailing Address - Phone:617-822-3603
Mailing Address - Fax:832-825-3633
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:CC 1010.00
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:617-822-3603
Practice Address - Fax:832-825-3633
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231870208000000X
MA2208732080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics