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NPI Code Detail

MEDICARE: MARILYN BRAVO

MEDICARE: MARILYN BRAVO
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
1207P00000XEmergency Medicine Physician19587CA

General Provider Information

NPI Number : 1386446326
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN BRAVO
Provider Business Mailing Address
First Line : 2051 MARENGO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1352
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2051 MARENGO ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90033-1352
Country : US
Telephone Number : 323-409-7053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2025
Last Update Date : 04/16/2026

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Directions to “ MARILYN BRAVO ” Practice Location

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