Provider Demographics
NPI:1972380343
Name:BRAVO-MOLINA, LORENA ALEXSANDRA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:ALEXSANDRA
Last Name:BRAVO-MOLINA
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 1:10001 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131-2563
Mailing Address - Country:US
Mailing Address - Phone:847-733-1534
Mailing Address - Fax:
Practice Address - Street 1:10200 GRAND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131-3139
Practice Address - Country:US
Practice Address - Phone:847-733-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator