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General NPI Number Information
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NPI Number | 1346367778
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Entity Type | Individual
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Provider Name | BRUNO PATRICK GIANNOTTA D.C.
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5301 LAUREL CANYON BLVD STE 120
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City | VALLEY VILLAGE
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State | CA
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Zip | 91607-2768
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Country | US
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Telephone | 818-802-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 2465 SHIELDS ST
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City | LA CRESCENTA
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State | CA
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Zip | 91214-1544
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Country | US
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Telephone | 818-802-4477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 15211
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License Number State | CA
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