Provider Demographics
NPI:1568204964
Name:BRAVO, NAZARIO (CHW)
Entity type:Individual
Prefix:MR
First Name:NAZARIO
Middle Name:
Last Name:BRAVO
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16666 SMOKE TREE ST STE B4
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6100
Mailing Address - Country:US
Mailing Address - Phone:442-267-4444
Mailing Address - Fax:
Practice Address - Street 1:16666 SMOKE TREE ST STE B4
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6100
Practice Address - Country:US
Practice Address - Phone:442-267-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker