Provider Demographics
NPI:1679340145
Name:BRAVO ESPINOSA, CLAUDIA ELENA
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:ELENA
Last Name:BRAVO ESPINOSA
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 1:5760 OLD TAMPA HWY
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-9300
Mailing Address - Country:US
Mailing Address - Phone:786-208-0003
Mailing Address - Fax:
Practice Address - Street 1:5760 OLD TAMPA HWY
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-9300
Practice Address - Country:US
Practice Address - Phone:786-208-0003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-307483106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician