Healthcare Provider Details

I. General information

NPI: 1811798564
Provider Name (Legal Business Name): KAIA BRAVO RCSWI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22904 LYDEN DR UNIT 104
ESTERO FL
33928-7048
US

IV. Provider business mailing address

16048 HERONS VIEW DR
ALVA FL
33920-4650
US

V. Phone/Fax

Practice location:
  • Phone: 239-494-3951
  • Fax:
Mailing address:
  • Phone: 941-882-0646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberISW18360
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: