Provider Demographics
NPI:1972024131
Name:CAMISON BRAVO, LILIANA (MD)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:CAMISON BRAVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILIANA
Other - Middle Name:
Other - Last Name:CAMISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3600 FORBES AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3550 TERRACE STREET 675 SCAIFE HL
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-0001
Practice Address - Country:US
Practice Address - Phone:412-383-8082
Practice Address - Fax:412-383-8986
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT214452390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program