Healthcare Provider Details

I. General information

NPI: 1104818426
Provider Name (Legal Business Name): REGINA M BRUNO AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29017 CEDAR RD
LYNDHURST OH
44124-4073
US

IV. Provider business mailing address

PO BOX 567
CHAGRIN FALLS OH
44022-0567
US

V. Phone/Fax

Practice location:
  • Phone: 440-460-8000
  • Fax: 440-460-1759
Mailing address:
  • Phone: 216-464-5160
  • Fax: 216-464-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67000062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: