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1164672085 NPI number — ANDREA BRAVO RMT, PHARMD

NPI Number: 1164672085
Health Care Provider/Practitioner: ANDREA BRAVO RMT, PHARMD

Information about “1164672085” NPI (ANDREA BRAVO RMT, PHARMD) exists in 1164672085 in HTML format HTML  |  1164672085 in plain Text format TXT  |  1164672085 in PDF (Portable Document Format) PDF  |  1164672085 in an XML format XML  formats.

NPI Number : 1164672085 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164672085",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRAVO",
    "FirstName": "ANDREA",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "RMT, PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BRAVO",
    "OtherFirstName": "ANDREA",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "PHARMD",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "9382 JENNINGS RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MORRISON",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80465-9506",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "561-676-8391",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "17847 BRIAN WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JUPITER",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33478-5289",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "561-676-8391",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/27/2008",
    "LastUpdateDate": "03/31/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "PHA0021301",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225700000X",
          "TaxonomyName": "Massage Therapist",
          "LicenseNumber": "MA45592",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "PS53819",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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