Provider Demographics
NPI:1760773873
Name:BRAVO, CATHLEEN
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:
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 1:117 W TUNNELL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-4096
Mailing Address - Country:US
Mailing Address - Phone:058-614-4940
Mailing Address - Fax:805-614-0179
Practice Address - Street 1:1265 FURUKAWA WAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4929
Practice Address - Country:US
Practice Address - Phone:805-614-4940
Practice Address - Fax:805-614-0179
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker