Provider Demographics
NPI:1528493079
Name:BRAVO, PAMELA ANGELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANGELA
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 1:778 EASTSHORE TER UNIT 183
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2429
Mailing Address - Country:US
Mailing Address - Phone:214-650-3858
Mailing Address - Fax:
Practice Address - Street 1:778 EASTSHORE TER UNIT 183
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-2429
Practice Address - Country:US
Practice Address - Phone:214-650-3858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN233277164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse