Renato Ulises Bravo

Primary specialty

DentistTaxonomy code 122300000X

License

109197 Issued in CA

Practice address

1350 E Vista Way Ste 10
Vista, CA 92084-4037

Phone

(760) 208-1173

NPI assigned

Apr 26, 2022

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 CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Ronny Le Dental Corporation

  dba Vista Modern Dentistry Dental Group

  • Dentist
  • Vista, CA
  • NPI 1871147983
  NPD

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

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1962146738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3878 HENSON ST",
            "city": "RIVERDALE",
            "state": "CA",
            "postal_code": "936569215",
            "telephone_number": "559-824-9479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 E VISTA WAY STE 10",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920844037",
            "telephone_number": "760-208-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAVO",
        "first_name": "RENATO",
        "middle_name": "ULISES",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-26",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "109197",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Aurora Brady
• Lelia Brady
• Aubrey Brake, RBT
• Terri Lynn Brake, RADT-1
• Abigail E Brantl, PT
• Breath of Life
• Jay Edward Brechtel
• Angela Maria Bretton, FNP-BC
• Brian Mudd DDS PDC (Dental Specialty Care)
• Kathleen Marie Bright

• Dentist in Vista, CA
• Providers in Vista, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.