Provider Demographics
NPI:1922891704
Name:BRAVO PAREDES, EDUAR ALBAN
Entity type:Individual
Prefix:
First Name:EDUAR
Middle Name:ALBAN
Last Name:BRAVO PAREDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 BOOTH ST APT 1H
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4130
Mailing Address - Country:US
Mailing Address - Phone:480-586-0908
Mailing Address - Fax:
Practice Address - Street 1:6560 BOOTH ST APT 1H
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4130
Practice Address - Country:US
Practice Address - Phone:480-586-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program