Healthcare Provider Details

I. General information

NPI: 1871396895
Provider Name (Legal Business Name): DANIEL HERNANDO BRAVO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 SHERMAN WAY
WINNETKA CA
91306-2707
US

IV. Provider business mailing address

17732 ERWIN ST
ENCINO CA
91316-7215
US

V. Phone/Fax

Practice location:
  • Phone: 818-883-2273
  • Fax: 818-587-4866
Mailing address:
  • Phone: 818-442-4426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number95034476
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: