Provider Demographics
NPI:1033268834
Name:BRAVO, ALFONSO JOSE (LSA)
Entity type:Individual
Prefix:MR
First Name:ALFONSO
Middle Name:JOSE
Last Name:BRAVO
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:23723 SWEET ACACIA TRL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3733
Mailing Address - Country:US
Mailing Address - Phone:832-512-4011
Mailing Address - Fax:
Practice Address - Street 1:23723 SWEET ACACIA TRL
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-3733
Practice Address - Country:US
Practice Address - Phone:832-512-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1891155289OtherXCITE SURGICAL
TX1518452614OtherBLU STAR SURGICAL ASSISTANTS
TX1144573734OtherUNIVERSAL SURGICAL PARTNERS
TX1720650948OtherUS MSO
TX1144573734Medicaid
TX1215220116OtherUNIVERSAL SURGICAL ASSISTANTS