Healthcare Provider Details

I. General information

NPI: 1942233192
Provider Name (Legal Business Name): EVELIO FELIX BRAVO-FERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE DOMENECH STE 604 LAS AMERICAS PROF CENTER
SAN JUAN PR
00918-3706
US

IV. Provider business mailing address

400 AVE DOMENECH STE 604 LAS AMERICAS PROF CENTER
SAN JUAN PR
00918-3706
US

V. Phone/Fax

Practice location:
  • Phone: 787-282-7681
  • Fax: 787-756-7621
Mailing address:
  • Phone: 787-282-7681
  • Fax: 787-756-7621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number6827
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: