Provider Demographics
NPI:1891245346
Name:BRUNO, CHELSIE (LAC)
Entity Type:Individual
Prefix:
First Name:CHELSIE
Middle Name:
Last Name:BRUNO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S TWIN OAKS VALLEY RD
Mailing Address - Street 2:#107-280
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4303
Mailing Address - Country:US
Mailing Address - Phone:760-805-9552
Mailing Address - Fax:760-304-8810
Practice Address - Street 1:6037 LA GRANADA
Practice Address - Street 2:SUITE C
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92067
Practice Address - Country:US
Practice Address - Phone:760-805-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-08
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17241171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist