MEDICARE: FERNANDO B BRAVO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A72360	CA
2	207R00000X	Internal Medicine Physician	A72360	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00358772	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	A72360	OTHER	CA	CA LICENSE

General Provider Information

NPI Number	:	1245262104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO B BRAVO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 20207
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93390-0207
Country	:	US
Telephone Number	:	661-327-4712
Fax Number	:	661-327-4004

Provider Business Practice Location Address
First Line	:	3110 LATTE LANE
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93312-2141
Country	:	US
Telephone Number	:	661-327-4712
Fax Number	:	661-327-4004

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	10/04/2013

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