Healthcare Provider Details

I. General information

NPI: 1396939898
Provider Name (Legal Business Name): ADRIANNA M BRAVO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N QUAKER LN
ALEXANDRIA VA
22302-3004
US

IV. Provider business mailing address

1200 N QUAKER LN
ALEXANDRIA VA
22302-3004
US

V. Phone/Fax

Practice location:
  • Phone: 571-334-9591
  • Fax:
Mailing address:
  • Phone: 571-334-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101248208
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC193520
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number041894
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME172870
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: