Provider Demographics
NPI:1164482220
Name:BRAVO COLON, ALFREDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:A
Last Name:BRAVO COLON
Suffix:
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 1:609 AVE TITO CASTRO
Mailing Address - Street 2:PMB 222 SUITE 102
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-0200
Mailing Address - Country:US
Mailing Address - Phone:787-844-6230
Mailing Address - Fax:787-848-4737
Practice Address - Street 1:2907 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3613
Practice Address - Country:US
Practice Address - Phone:787-844-6230
Practice Address - Fax:787-848-4737
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9336207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081652Medicare ID - Type Unspecified
E20110Medicare UPIN