Provider Demographics
NPI:1013938810
Name:BRAVO, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:BRAVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 79 ST CSWY
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4188
Mailing Address - Country:US
Mailing Address - Phone:305-763-8573
Mailing Address - Fax:305-763-8574
Practice Address - Street 1:1440 79 ST CSWY
Practice Address - Street 2:SUITE 1400
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4188
Practice Address - Country:US
Practice Address - Phone:305-763-8573
Practice Address - Fax:305-763-8574
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME914642084P0800X
FLME 91464208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267682600Medicaid
H79303Medicare UPIN
U02322Medicare ID - Type Unspecified