Provider Demographics
NPI:1518918978
Name:BRAVO-FERNANDEZ, CARIDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:CARIDAD
Middle Name:
Last Name:BRAVO-FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:HOSPITAL BASED @ FROEDTERT HOSP.
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15262 N. 75TH AVENUE,
Practice Address - Street 2:SUITE 400 PAIN SOLUTION CENTER, LLC
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4762
Practice Address - Country:US
Practice Address - Phone:623-486-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45254207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
004806261HOtherHUMANA
WI31543500Medicaid
B47282Medicare UPIN
WI31543500Medicaid