Healthcare Provider Details

I. General information

NPI: 1225615248
Provider Name (Legal Business Name): MOISES BRAVO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 EAST 31ST STREET, QIC 22123
OAKLAND CA
94602-1092
US

IV. Provider business mailing address

3117 WINTER SUNSET AVE
NORTH LAS VEGAS NV
89081-6497
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number27050
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: