Provider Demographics
NPI:1053309260
Name:BRAVO VALVERDE, RUBEN L SR (MD)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:L
Last Name:BRAVO VALVERDE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3050
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-3050
Mailing Address - Country:US
Mailing Address - Phone:787-780-3752
Mailing Address - Fax:787-787-0412
Practice Address - Street 1:COMDOMINIO LAS TORRES
Practice Address - Street 2:SUR 1-B
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-780-3752
Practice Address - Fax:787-787-0412
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR142402084F0202X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0020986Medicare ID - Type Unspecified
H79754Medicare UPIN