Provider Demographics
NPI:1376524306
Name:BELKYS BRAVO MD PA
Entity Type:Organization
Organization Name:BELKYS BRAVO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANDIARAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-250-9910
Mailing Address - Street 1:1920 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2624
Mailing Address - Country:US
Mailing Address - Phone:305-250-9910
Mailing Address - Fax:305-250-4336
Practice Address - Street 1:1920 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2624
Practice Address - Country:US
Practice Address - Phone:305-250-9910
Practice Address - Fax:305-250-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0064617208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL270905800Medicaid