Provider Demographics
NPI:1528488350
Name:BRAVO, ARLENE (MD)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:
Last Name:BRAVO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21832 CACTUS AVE.
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92518
Mailing Address - Country:US
Mailing Address - Phone:951-924-6500
Mailing Address - Fax:855-306-0135
Practice Address - Street 1:SOUTHLAND ARTHRITIS AND OSTEOPOROSIS MEDICAL CENTER
Practice Address - Street 2:31515 RANCHO PUEBLO RD. #203
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-303-1500
Practice Address - Fax:855-306-0135
Is Sole Proprietor?:No
Enumeration Date:2014-04-19
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142116208M00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist