Basic Information
| Provider Information | |||||||||
| NPI: | 1972788735 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAVO-CUEVAS | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 261 DORADO BCH E | ||||||||
| Address2: | |||||||||
| City: | DORADO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006462212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872265912 | ||||||||
| FaxNumber: | 7878541452 | ||||||||
| Practice Location | |||||||||
| Address1: | COOP CIUDAD UNIVERSITARIA | ||||||||
| Address2: | G10 AVE PERIFERAL | ||||||||
| City: | TRUJILLO ALTO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009760001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872265912 | ||||||||
| FaxNumber: | 7877608405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2007 | ||||||||
| LastUpdateDate: | 01/23/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 18222 | PR | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.