Provider Demographics
NPI:1386611960
Name:BRAVO CASTRO, JAIME JOSE (MD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:JOSE
Last Name:BRAVO CASTRO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:165 CALLE REINA ISABEL
Mailing Address - Street 2:LA VILLA DE TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3284
Mailing Address - Country:US
Mailing Address - Phone:787-781-5153
Mailing Address - Fax:787-793-8341
Practice Address - Street 1:1785 CARR 21
Practice Address - Street 2:HOSPITAL METROPOLITANO SUITE 202
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3399
Practice Address - Country:US
Practice Address - Phone:787-781-5153
Practice Address - Fax:787-793-8341
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2017-12-08
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Provider Licenses
StateLicense IDTaxonomies
PR6250207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098579Medicare ID - Type Unspecified