Provider Demographics
NPI:1861448052
Name:MANCINI, BRUNO ALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:ALDO
Last Name:MANCINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRUNO
Other - Middle Name:ALDO
Other - Last Name:MANCINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:121 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-3221
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-657-9688
Practice Address - Street 1:810 N NOWELL ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7539
Practice Address - Country:US
Practice Address - Phone:407-290-9556
Practice Address - Fax:407-290-9509
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 97950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF053YOtherMEDICARE
FLAF053YOtherMEDICARE