Healthcare Provider Details

I. General information

NPI: 1285606830
Provider Name (Legal Business Name): LETICIA ESCASA BRAVO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2057
US

IV. Provider business mailing address

8705 162ND AVE
HOWARD BEACH NY
11414-3311
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-2891
  • Fax:
Mailing address:
  • Phone: 718-835-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number133850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: