Provider Demographics
NPI:1447797659
Name:BRAVO, JUAN JR
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:BRAVO
Suffix:JR
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 1:12179 RHONE CT
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2778
Mailing Address - Country:US
Mailing Address - Phone:951-816-7554
Mailing Address - Fax:
Practice Address - Street 1:12179 RHONE CT
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91752-2778
Practice Address - Country:US
Practice Address - Phone:951-816-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7284237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist