Provider Demographics
NPI:1972822674
Name:BRAVO DME LLC
Entity type:Organization
Organization Name:BRAVO DME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPHAT
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-784-0313
Mailing Address - Street 1:902 OLD AUSTIN HUTTO RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4116
Mailing Address - Country:US
Mailing Address - Phone:512-990-5440
Mailing Address - Fax:
Practice Address - Street 1:902 OLD AUSTIN HUTTO RD
Practice Address - Street 2:SUITE 102
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-4116
Practice Address - Country:US
Practice Address - Phone:512-990-5440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX801218214332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies