Provider Demographics
NPI:1851905392
Name:DELIMA-MUJICA, BRUNA
Entity Type:Individual
Prefix:
First Name:BRUNA
Middle Name:
Last Name:DELIMA-MUJICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WILD MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-1688
Mailing Address - Country:US
Mailing Address - Phone:810-542-0285
Mailing Address - Fax:
Practice Address - Street 1:102 WILD MAGNOLIA CIR
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-1688
Practice Address - Country:US
Practice Address - Phone:810-542-0285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA215412363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily