Individual
LETICIA BRAVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1411 N RACE ST, GLASGOW, KY 42141-3474
(270) 651-9755
(270) 651-7562
Mailing address
1411 N RACE ST, GLASGOW, KY 42141-3474
(270) 651-9755
(270) 651-7562
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
171002
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64171002
—
KY
Enumeration date
02/15/2007
Last updated
07/08/2007
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