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General NPI Number Information
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NPI Number | 1083261119
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Entity Type | Organization
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Legal Business Name | RAQUEL A BRAVO DMD PA
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 10511 SW 88TH ST STE C101
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City | MIAMI
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State | FL
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Zip | 33176-1537
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Country | US
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Telephone | 786-507-1551
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Fax | 786-507-1554
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Provider Business Mailing Address
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Address Line | 10711 SW 27TH ST
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City | MIAMI
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State | FL
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Zip | 33165-2407
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Country | US
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Telephone | 786-385-9522
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Fax | 786-507-1551
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Authorized Official
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Title or Position | OWNER
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Name | RAQUEL A BRAVO
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Credential | DMD
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Telephone | 786-385-9522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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