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General NPI Number Information
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NPI Number | 1295078590
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Entity Type | Organization
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Legal Business Name | BRAVO HEALTHCARE LLLP
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 1140 BUSINESS CENTER DR STE 100
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City | HOUSTON
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State | TX
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Zip | 77043-2740
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Country | US
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Telephone | 713-464-7768
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Fax | 713-464-2436
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Provider Business Mailing Address
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Address Line | 1140 BUSINESS CENTER DR STE 100
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City | HOUSTON
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State | TX
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Zip | 77043-2740
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Country | US
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Telephone | 713-464-7768
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Fax | 713-464-2436
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | CESAR BRAVO
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Credential | M.D.
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Telephone | 713-464-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | E9550
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License Number State | TX
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