Provider Demographics
NPI:1740224690
Name:BRAVO, ROSALIE D (RN, NP)
Entity Type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:D
Last Name:BRAVO
Suffix:
Gender:F
Credentials:RN, NP
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Mailing Address - Street 1:1635 DIVISADERO STREET
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-353-1238
Practice Address - Fax:415-353-1799
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA377368363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA003773680Medicaid
CA003773680Medicare PIN
CA003773680Medicaid