Healthcare Provider Details

I. General information

NPI: 1003254186
Provider Name (Legal Business Name): CLAUDIO ANDRES BRAVO CARRILLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

535 MISSION BAY BLVD S
SAN FRANCISCO CA
94143-2156
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-4243
  • Fax: 415-502-0243
Mailing address:
  • Phone: 415-353-2873
  • Fax: 415-353-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD61040173
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberU6120
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberC200774
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberU6120
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: