Healthcare Provider Details

I. General information

NPI: 1962334045
Provider Name (Legal Business Name): BRAVO DERMATOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70473 LANDRY KATE LN
COVINGTON LA
70433-5625
US

IV. Provider business mailing address

474 S CHENIER DR
MADISONVILLE LA
70447-9389
US

V. Phone/Fax

Practice location:
  • Phone: 985-205-8113
  • Fax:
Mailing address:
  • Phone: 985-205-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MONICA BRAVO
Title or Position: DERMATOLOGIST/OWNER
Credential: MD
Phone: 985-237-8694