Provider Demographics
NPI:1972327823
Name:BRAVO LUNA, PEDRO FERNANDO
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:FERNANDO
Last Name:BRAVO LUNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 ANNACELLA AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7956
Mailing Address - Country:US
Mailing Address - Phone:689-203-2567
Mailing Address - Fax:
Practice Address - Street 1:2424 ANNACELLA AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7956
Practice Address - Country:US
Practice Address - Phone:689-203-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)