Provider Demographics
NPI:1104654763
Name:BRAVO, NATALIA S
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:S
Last Name:BRAVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12049 PIONEERS WAY APT 2418
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-2817
Mailing Address - Country:US
Mailing Address - Phone:787-206-2220
Mailing Address - Fax:
Practice Address - Street 1:12049 PIONEERS WAY APT 2418
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-2817
Practice Address - Country:US
Practice Address - Phone:787-206-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT25322225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist