Provider Demographics
NPI:1447273594
Name:BRAVO, ANDRES ARMANDO (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:ARMANDO
Last Name:BRAVO
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:425 N DATE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3413
Mailing Address - Country:US
Mailing Address - Phone:760-737-6931
Mailing Address - Fax:760-741-2782
Practice Address - Street 1:460 N ELM ST- NEIGHBORHOOD HEALTHCARE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3002
Practice Address - Country:US
Practice Address - Phone:760-520-8100
Practice Address - Fax:858-633-4691
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12274363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant