Provider Demographics
NPI:1992819759
Name:BRAVO, GABRIEL (PA-C)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:BRAVO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 HERITAGE OAK LN
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4250
Mailing Address - Country:US
Mailing Address - Phone:269-979-6360
Mailing Address - Fax:269-979-6380
Practice Address - Street 1:2 HERITAGE OAK LN
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4250
Practice Address - Country:US
Practice Address - Phone:269-979-6360
Practice Address - Fax:269-979-6380
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003760363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical