Provider Demographics
NPI:1942233192
Name:BRAVO-FERNANDEZ, EVELIO FELIX (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELIO
Middle Name:FELIX
Last Name:BRAVO-FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 AVE DOMENECH STE 604
Mailing Address - Street 2:LAS AMERICAS PROF CENTER
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3706
Mailing Address - Country:US
Mailing Address - Phone:787-282-7681
Mailing Address - Fax:787-756-7621
Practice Address - Street 1:400 AVE DOMENECH STE 604
Practice Address - Street 2:LAS AMERICAS PROF CENTER
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3706
Practice Address - Country:US
Practice Address - Phone:787-282-7681
Practice Address - Fax:787-756-7621
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6827207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6827OtherMEDICAL LICENSE
PR6827OtherMEDICAL LICENSE