Individual
JAN S BRAVO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2105 FOREST AVE, SAN JOSE, CA 95128-1425
(408) 947-2500
(818) 587-2493
Mailing address
PO BOX 4419, WOODLAND HILLS, CA 91365-4419
(888) 620-3100
(818) 587-2493
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A43844
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A438440
BLUE SHIELD
CA
05
—
00A438440
—
CA
Enumeration date
06/01/2006
Last updated
08/04/2014
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