Healthcare Provider Details

I. General information

NPI: 1962937177
Provider Name (Legal Business Name): CHERRIE BRAVO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26740 TOWNE CENTRE DR
FOOTHILL RANCH CA
92610-2839
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-9293
  • Fax: 949-588-0409
Mailing address:
  • Phone: 702-579-3203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA158914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: