Gary Lewis Bravo

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

G53626 Issued in CA

Practice address

3322 Chanate Rd
Santa Rosa, CA 95404-1708

Phone

(707) 565-4997

NPI assigned

Dec 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Sonoma

  • Community Health Clinic/Center
  • Cloverdale, CA
  • NPI 1952637027
  Medicare reassignment NPD
• County of Sonoma

  • Adolescent and Children Mental Health Clinic/Center
  • Santa Rosa, CA
  • NPI 1457498636
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403222400000",
    "number": "1669536009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3322 CHANATE RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954041708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3322 CHANATE RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954041708",
            "telephone_number": "707-565-4997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAVO",
        "first_name": "GARY",
        "middle_name": "LEWIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2014-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G53626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald James Brauner
• Elizabeth Braunreuther, MD
• Daisy Nereyda Bravo Lagunas
• Luis Enrique Bravo-Avina
• Daniela Bravo
• Jennifer Brayton
• Kimberly Brayton Brayton, M.D.
• Jacqueline Elizabeth Brazieal, PT
• Janne Breadon, MD
• Kevin Louis Breaux

• Psychiatry Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.