Provider Demographics
NPI:1235463654
Name:PATRICIA BRAVO M.D,P.A
Entity Type:Organization
Organization Name:PATRICIA BRAVO M.D,P.A
Other - Org Name:BRAVO HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-763-8573
Mailing Address - Street 1:1440 79TH STREET CSWY
Mailing Address - Street 2:SUITE #1400
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4188
Mailing Address - Country:US
Mailing Address - Phone:305-763-8573
Mailing Address - Fax:305-763-8574
Practice Address - Street 1:1440 79TH STREET CSWY
Practice Address - Street 2:SUITE #1400
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4188
Practice Address - Country:US
Practice Address - Phone:305-763-8573
Practice Address - Fax:305-763-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QA0505X
FLME 914642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1235463654OtherNPI
FL267682600Medicaid
FL267682600Medicaid