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General NPI Number Information
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NPI Number | 1548381890
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Entity Type | Individual
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Provider Name | MATIAS BRUZONI MD
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 9835 N LAKE CREEK PKWY
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City | AUSTIN
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State | TX
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Zip | 78717-6210
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Country | US
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Telephone | 372-293-5117
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Fax |
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Provider Business Mailing Address
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Address Line | 725 WELCH RD
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City | PALO ALTO
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State | CA
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Zip | 94304-1601
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Country | US
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Telephone | 650-497-8000
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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 | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | U5648
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A105639
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2086S0120X
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Taxonomy Name | Pediatric Surgery Physician
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License Number | A105639
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License Number State | CA
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