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General NPI Number Information
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NPI Number | 1710779871
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Entity Type | Individual
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Provider Name | JESSICA DONATE BRUNO
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Gender | Female
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | PO BOX 4956
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City | CAGUAS
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State | PR
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Zip | 00726-4956
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Country | US
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Telephone | 787-744-4824
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Fax |
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Provider Business Mailing Address
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Address Line | LA CIMA I 678 CALLE BARAJAS
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City | CAGUAS
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State | PR
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Zip | 00727-1377
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Country | US
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Telephone | 787-313-0865
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Fax | 787-313-0865
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2175
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License Number State | PR
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