Provider Demographics
NPI:1497522775
Name:CLINICA MEDICA BRAVO LLC
Entity Type:Organization
Organization Name:CLINICA MEDICA BRAVO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL TORO BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:737-333-1263
Mailing Address - Street 1:4534 HIGHWAY 6 N.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084
Mailing Address - Country:US
Mailing Address - Phone:346-342-1652
Mailing Address - Fax:832-664-8574
Practice Address - Street 1:8795 ANTOINE DR. SUITE 115
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088
Practice Address - Country:US
Practice Address - Phone:346-342-1652
Practice Address - Fax:832-664-8574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty