=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609020841
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARMEN SIVILA BRUNO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2008
-----------------------------------------------------
Last Update Date | 05/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 955 NW 3RD ST 105
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33128-1274
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-324-9494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8777 COLLINS AVE APT 310
-----------------------------------------------------
City | SURFSIDE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33154-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-864-5381
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | ME 100367
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------