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General NPI Number Information
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NPI Number | 1649810425
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Entity Type | Individual
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Provider Name | ALAN DO VALE BRAVO PT
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Gender | Male
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Dates
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Enumeration Date | 01/09/2020
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 25333 BARTON RD
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City | LOMA LINDA
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State | CA
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Zip | 92350
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Country | US
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Telephone | 909-558-6760
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Fax |
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Provider Business Mailing Address
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Address Line | 249A CRESCENT RD
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City | SAN ANSELMO
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State | CA
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Zip | 94960-2744
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Country | US
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Telephone | 415-497-8849
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 292600
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License Number State | CA
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