MEDICARE: MRS. CARMEN SIVILA BRUNO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	ME 100367	FL

General Provider Information

NPI Number	:	1609020841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARMEN SIVILA BRUNO MD

Provider Business Mailing Address
First Line	:	8777 COLLINS AVE APT 310
Second Line	:
City	:	SURFSIDE
State	:	FL
Zip	:	33154-3408
Country	:	US
Telephone Number	:	305-864-5381
Fax Number	:

Provider Business Practice Location Address
First Line	:	955 NW 3RD ST
Second Line	:	105
City	:	MIAMI
State	:	FL
Zip	:	33128-1274
Country	:	US
Telephone Number	:	305-324-9494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	05/22/2009

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