Provider Demographics
NPI:1063539575
Name:BRUZZONE, DANIEL ERNESTO (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ERNESTO
Last Name:BRUZZONE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 SKYPARK DR
Mailing Address - Street 2:STE 215
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5388
Mailing Address - Country:US
Mailing Address - Phone:310-855-3990
Mailing Address - Fax:310-684-5516
Practice Address - Street 1:2790 SKYPARK DR
Practice Address - Street 2:STE 215
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5388
Practice Address - Country:US
Practice Address - Phone:310-855-3990
Practice Address - Fax:310-684-5516
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26003103TC0700X, 103TA0700X, 103TC2200X, 103TB0200X, 103TF0000X, 103TF0200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy