Provider Demographics
NPI:1417599390
Name:BRAVO, ANDREINA (CBHCM)
Entity Type:Individual
Prefix:
First Name:ANDREINA
Middle Name:
Last Name:BRAVO
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 NE 180TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-1141
Mailing Address - Country:US
Mailing Address - Phone:786-443-7162
Mailing Address - Fax:
Practice Address - Street 1:870 NE 180TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-1141
Practice Address - Country:US
Practice Address - Phone:786-443-7162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator