Healthcare Provider Details

I. General information

NPI: 1225953458
Provider Name (Legal Business Name): MICHELLE ANDREA BRAVO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12942 MAGNOLIA BLVD
SHERMAN OAKS CA
91423-1619
US

IV. Provider business mailing address

12942 MAGNOLIA BLVD
SHERMAN OAKS CA
91423-1619
US

V. Phone/Fax

Practice location:
  • Phone: 818-964-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95424260
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95424260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: