MEDICARE: FERNANDO B BRAVO MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	A72360	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF3572	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043257314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FERNANDO B BRAVO MD INC

Provider Business Mailing Address
First Line	:	PO BOX 20207
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93390-0207
Country	:	US
Telephone Number	:	661-327-4712
Fax Number	:	661-327-4004

Provider Business Practice Location Address
First Line	:	3110 LATTE LANE
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-2141
Country	:	US
Telephone Number	:	661-327-4712
Fax Number	:	661-327-4004

Authorized Official
Title or Position	:	PRESIDENT/PHYSICIAN
Name	:	MR. FERNANDO B. BRAVO
Credential	:	M.D.
Telephone Number	:	661-327-4712

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/28/2013

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