Provider Demographics
NPI:1033268834
Name:BRAVO, ALFONSO JOSE (LSA)
Entity Type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:JOSE
Last Name:BRAVO
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:STE 618
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3560
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3560
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00284363AS0400X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8RA814OtherXCITE SURGICAL
TX8RA776OtherBLUE STAR SURGICAL ASSISTANTS
TX8RA621OtherUS MSO
TX8RA622OtherUNIVERSAL SURGICAL ASSISTANTS
TX8RA623OtherUNIVERSAL SURGICAL PARTNERS