Healthcare Provider Details

I. General information

NPI: 1023233202
Provider Name (Legal Business Name): JEFFREY JOSEPH BRUNO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 EUREKA SQ SUITE 215
PACIFICA CA
94044-2654
US

IV. Provider business mailing address

2338 BEACH BLVD
PACIFICA CA
94044-2700
US

V. Phone/Fax

Practice location:
  • Phone: 650-738-0807
  • Fax: 650-738-0807
Mailing address:
  • Phone: 650-738-0807
  • Fax: 650-738-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number13149
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number13149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: