Healthcare Provider Details

I. General information

NPI: 1760689426
Provider Name (Legal Business Name): YOVANA BRUNO PEDIATRIC CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 CAMINO MIRA COSTA STE D
SAN CLEMENTE CA
92672-3512
US

IV. Provider business mailing address

3553 CAMINO MIRA COSTA STE D
SAN CLEMENTE CA
92672-3512
US

V. Phone/Fax

Practice location:
  • Phone: 949-200-7737
  • Fax: 949-336-1949
Mailing address:
  • Phone: 949-200-7737
  • Fax: 949-336-1949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: YOVANA GRACIELA BRUNO
Title or Position: OWNER
Credential: M.D
Phone: 949-200-7737