MEDICARE: BRAVO GERIATRICS

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	43580	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z145166	OTHER	AZ	MEDICARE

General Provider Information

NPI Number	:	1528358322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAVO GERIATRICS

Provider Business Mailing Address
First Line	:	PO BOX 12674
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85732-2674
Country	:	US
Telephone Number	:	520-990-3222
Fax Number	:	520-867-6409

Provider Business Practice Location Address
First Line	:	4716 E BURNS ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3015
Country	:	US
Telephone Number	:	520-990-3222
Fax Number	:	520-867-6409

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHANIE BRAVO
Credential	:	M.D.
Telephone Number	:	520-990-3222

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	11/03/2011

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Directions to “BRAVO GERIATRICS ” Practice Location

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