Provider Demographics
NPI:1932587490
Name:GARCIA, VIRIDIANA BRAVO
Entity Type:Individual
Prefix:
First Name:VIRIDIANA
Middle Name:BRAVO
Last Name:GARCIA
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 1:3178 GLENHURST DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3321
Mailing Address - Country:US
Mailing Address - Phone:702-493-2245
Mailing Address - Fax:
Practice Address - Street 1:3178 GLENHURST DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3321
Practice Address - Country:US
Practice Address - Phone:702-493-2245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner