Provider Demographics
NPI:1073635744
Name:BRAVO, ADRIAN J (BA)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:J
Last Name:BRAVO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2231 ROCK BLVD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2054
Mailing Address - Country:US
Mailing Address - Phone:775-331-5127
Mailing Address - Fax:775-857-2998
Practice Address - Street 1:1201 CORPORATE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-7101
Practice Address - Country:US
Practice Address - Phone:775-857-2999
Practice Address - Fax:775-857-2998
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1101-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)