Individual
DR. MADELEINE DISTASO BRUNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1200 N STATE ST, IRD 116, LOS ANGELES, CA 90089-2211
(323) 226-5609
Mailing address
1200 N STATE ST, IRD 116, LOS ANGELES, CA 90089-2211
(323) 226-5609
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
269108
CA
Other
Enumeration date
01/12/2011
Last updated
01/12/2011
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