Provider Demographics
NPI:1982477980
Name:BRAVO, GABRIELA NATALIE
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:NATALIE
Last Name:BRAVO
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 1:2303 14TH ST NW APT 810
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4150
Mailing Address - Country:US
Mailing Address - Phone:909-996-5951
Mailing Address - Fax:
Practice Address - Street 1:2303 14TH ST NW APT 810
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4150
Practice Address - Country:US
Practice Address - Phone:909-996-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC5333248106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician