Provider Demographics
NPI:1881089746
Name:JORDAN BRUNO, XIMENA (MD)
Entity type:Individual
Prefix:DR
First Name:XIMENA
Middle Name:
Last Name:JORDAN BRUNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3400 SPRUCE STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4204
Mailing Address - Country:US
Mailing Address - Phone:215-615-0063
Mailing Address - Fax:215-349-8144
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4204
Practice Address - Country:US
Practice Address - Phone:215-615-0063
Practice Address - Fax:215-349-8144
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD474997207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology