Provider Demographics
NPI:1619160744
Name:BRAVO, MARTA JOSEFA
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:JOSEFA
Last Name:BRAVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 EL CAMPO DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4156
Mailing Address - Country:US
Mailing Address - Phone:415-905-5555
Mailing Address - Fax:
Practice Address - Street 1:350 TOWNSEND ST STE 205
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1673
Practice Address - Country:US
Practice Address - Phone:415-905-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)