| Doctor Name: | FLORESITA B BRAVO EDORA |
| NPI Number: | 1407864465 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 12375 |
| Business Practice Address: | 135 South Penn Avenue Harrisville, WV - 263620373 |
| Business Phone Number: | 3046434005 |
| Business Fax Number: | 3046434007 |
| Mailing Address: | Po Box 373, 135 South Penn Avenue HARRISVILLE |
| State: | WV |
| Postal Code: | 263620373 |
| Phone Number: | 3046434005 |
| Fax Number: | 3046434007 |
| NPI Enumeration Date: | 08/04/2006 |
| NPI Last Update Date: | 05/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 12375 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |