Healthcare Provider Details

I. General information

NPI: 1538153135
Provider Name (Legal Business Name): CARLOS A BRUNO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 ALBERTSON PKWY SUITE A
BROUSSARD LA
70518-5256
US

IV. Provider business mailing address

811 ALBERTSONS PARKWAY SUITE A
BROUSSARD LA
70518
US

V. Phone/Fax

Practice location:
  • Phone: 337-839-2265
  • Fax: 337-839-2213
Mailing address:
  • Phone: 337-839-2265
  • Fax: 337-839-2213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number022562
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: