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General NPI Number Information
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NPI Number | 1295868024
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Entity Type | Organization
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Legal Business Name | SANDRA D.M. BRUNO, M.D., LLC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 217 SAM HOUSTON JONES PKWY SUITE 101
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City | LAKE CHARLES
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State | LA
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Zip | 70611-5603
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Country | US
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Telephone | 337-217-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 217 SAM HOUSTON JONES PKWY SUITE 101
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City | LAKE CHARLES
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State | LA
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Zip | 70611-5603
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Country | US
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Telephone | 337-217-1000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA D BRUNO
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Credential | MD
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Telephone | 337-217-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 020956
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License Number State | LA
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