Healthcare Provider Details

I. General information

NPI: 1336120690
Provider Name (Legal Business Name): PATRICIO GIOVANNI BRUNO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 TURKEY LAKE RD
ORLANDO FL
32819-8001
US

IV. Provider business mailing address

9400 TURKEY LAKE RD
ORLANDO FL
32819-8001
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-8505
  • Fax: 321-843-5550
Mailing address:
  • Phone: 321-842-8505
  • Fax: 321-843-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS12047
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS12047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: