Provider Demographics
NPI:1295618007
Name:BRAVO, SURUAMI NAYELI
Entity type:Individual
Prefix:
First Name:SURUAMI
Middle Name:NAYELI
Last Name:BRAVO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 W LA VETA AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4439
Mailing Address - Country:US
Mailing Address - Phone:714-737-8453
Mailing Address - Fax:
Practice Address - Street 1:725 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4403
Practice Address - Country:US
Practice Address - Phone:714-737-8453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator