Provider Demographics
NPI:1629262175
Name:BRAVO, LULETTE TRICIA CARANDANG (MD)
Entity Type:Individual
Prefix:DR
First Name:LULETTE TRICIA
Middle Name:CARANDANG
Last Name:BRAVO
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:CLEVELAND CLINIC FOUNDATION
Mailing Address - Street 2:9500 EUCLID AVENUE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-3606
Mailing Address - Fax:
Practice Address - Street 1:CLEVELAND CLINIC FOUNDATION DEPT OF INFECTIOUS DISEASE
Practice Address - Street 2:S32, 9500 EUCLID AVENUE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35091882207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2855576Medicaid
OH7389081Medicare PIN