Healthcare Provider Details

I. General information

NPI: 1053229302
Provider Name (Legal Business Name): FABIOLA CAROLINA BRAVO VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5085 NW 7TH ST APT 1015
MIAMI FL
33126-3456
US

IV. Provider business mailing address

5085 NW 7TH ST
MIAMI FL
33126-3460
US

V. Phone/Fax

Practice location:
  • Phone: 786-938-0026
  • Fax:
Mailing address:
  • Phone: 786-938-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAADC-05-20-1852
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: