Provider Demographics
NPI:1205065299
Name:BRACAMONTE VALENCIA, ROBERTO IGOR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:IGOR
Last Name:BRACAMONTE VALENCIA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W ECHO LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5554
Mailing Address - Country:US
Mailing Address - Phone:602-350-3046
Mailing Address - Fax:866-845-1832
Practice Address - Street 1:301 W ECHO LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5554
Practice Address - Country:US
Practice Address - Phone:602-350-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-10
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ426222084P0804X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry