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General NPI Number Information
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NPI Number | 1427551878
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Entity Type | Individual
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Provider Name | ERNESTO LEANDRO BRAVO GONZALEZ
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Gender | Male
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 4700 SHERIDAN ST STE A1
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3416
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Country | US
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Telephone | 954-966-1166
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Fax |
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Provider Business Mailing Address
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Address Line | 5710 ATLANTA ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-2717
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Country | US
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Telephone | 781-990-6564
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 25161
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License Number State | FL
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