Doctor Name: | HECTOR BRAVO |
NPI Number: | 1255744306 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 6000 Kanakanak Rd. Dillingham, AK - 995760130 |
Business Phone Number: | 9078425266 |
Business Fax Number: | 9078425915 |
Mailing Address: | Po Box 130, DILLINGHAM |
State: | AK |
Postal Code: | 995760130 |
Phone Number: | 9078425266 |
Fax Number: | 9078425915 |
NPI Enumeration Date: | 06/06/2014 |
NPI Last Update Date: | 06/06/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |