MEDICARE: TOMAS BRAVO JR

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1437009099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMAS BRAVO JR

Provider Business Mailing Address
First Line	:	PO BOX 2523
Second Line	:
City	:	SUNLAND PARK
State	:	NM
Zip	:	88063-2523
Country	:	US
Telephone Number	:	575-915-1338
Fax Number	:	575-915-1819

Provider Business Practice Location Address
First Line	:	5312 RIO BRAVO DR
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9210
Country	:	US
Telephone Number	:	575-915-1338
Fax Number	:	575-915-1819

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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