Organization
CLAIRE BRAVO, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLAIRE BRAVO MD (PRESIDENT)
(310) 274-9977
Entity
Organization
Contact information
Practice address
6310 SAN VICENTE BLVD STE 220, LOS ANGELES, CA 90048-5458
(310) 274-9988
(310) 274-0595
Mailing address
6310 SAN VICENTE BLVD STE 220, LOS ANGELES, CA 90048-5458
(818) 429-8122
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A108032
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477847309
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
07/27/2017
Last updated
11/06/2017
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