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General NPI Number Information
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NPI Number | 1245262104
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Entity Type | Individual
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Provider Name | FERNANDO B BRAVO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 10/04/2013
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A72360
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A72360
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License Number State | CA
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