Provider Demographics
NPI:1083324388
Name:BRAVO LIRANZA, VALERIA MICHELLE (DMD)
Entity type:Individual
Prefix:
First Name:VALERIA
Middle Name:MICHELLE
Last Name:BRAVO LIRANZA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CALLE FARAGAN
Mailing Address - Street 2:CHALETS VILLA ANDALUCIA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-221-1266
Mailing Address - Fax:
Practice Address - Street 1:40 CALLE FARAGAN
Practice Address - Street 2:CHALETS VILLA ANDALUCIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-221-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35241223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery