Healthcare Provider Details

I. General information

NPI: 1568788511
Provider Name (Legal Business Name): OSVALDO A BRUSCO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5814 ESPLANADE DR
CORPUS CHRISTI TX
78414-4173
US

IV. Provider business mailing address

5814 ESPLANADE DR
CORPUS CHRISTI TX
78414-4173
US

V. Phone/Fax

Practice location:
  • Phone: 361-813-0684
  • Fax: 361-879-0982
Mailing address:
  • Phone: 361-813-0684
  • Fax: 361-879-0982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberK1785
License Number StateTX

VIII. Authorized Official

Name: DR. OSVALDO A BRUSCO II
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 361-813-0684