Provider Demographics
NPI:1194816223
Name:BRAVO, HECTOR M (AUD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:M
Last Name:BRAVO
Suffix:
Gender:M
Credentials:AUD
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 140271
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00614-0271
Mailing Address - Country:US
Mailing Address - Phone:787-878-0933
Mailing Address - Fax:787-878-9029
Practice Address - Street 1:MARIA CADILLA #51
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-878-0933
Practice Address - Fax:787-878-9029
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0516231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR64036Medicare ID - Type Unspecified
R62247Medicare UPIN