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General NPI Number Information
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NPI Number | 1043257314
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Entity Type | Organization
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Legal Business Name | FERNANDO B BRAVO MD INC
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 08/28/2013
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Provider Practice Location Address
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Address Line | 3110 LATTE LANE
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2141
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Country | US
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Telephone | 661-327-4712
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Fax | 661-327-4004
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Provider Business Mailing Address
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Address Line | PO BOX 20207
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City | BAKERSFIELD
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State | CA
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Zip | 93390-0207
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Country | US
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Telephone | 661-327-4712
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Fax | 661-327-4004
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | MR. FERNANDO B. BRAVO
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Credential | M.D.
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Telephone | 661-327-4712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | A72360
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License Number State | CA
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