Provider Demographics
NPI:1487953949
Name:BRAVO-ESPINOZA, MARIA VIRGINIA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA VIRGINIA
Middle Name:
Last Name:BRAVO-ESPINOZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6958
Mailing Address - Country:US
Mailing Address - Phone:909-240-3888
Mailing Address - Fax:
Practice Address - Street 1:16147 FOOTHILL BLVD
Practice Address - Street 2:A
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-0000
Practice Address - Country:US
Practice Address - Phone:909-251-4721
Practice Address - Fax:909-202-4967
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA601871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice