Provider Demographics
NPI:1831908458
Name:CD BRAVO INC
Entity type:Organization
Organization Name:CD BRAVO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRAVO BUXO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-685-6195
Mailing Address - Street 1:PO BOX 1392
Mailing Address - Street 2:
Mailing Address - City:SAINT JUST
Mailing Address - State:PR
Mailing Address - Zip Code:00978-1392
Mailing Address - Country:US
Mailing Address - Phone:877-648-6967
Mailing Address - Fax:
Practice Address - Street 1:1057 CALLE WILLIAM JONES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3856
Practice Address - Country:US
Practice Address - Phone:787-764-8696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty