Provider Demographics
NPI:1821535410
Name:BRAVE, LESLIE
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:
Last Name:BRAVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 N GILPIN ST
Mailing Address - Street 2:UNIT 610
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2552
Mailing Address - Country:US
Mailing Address - Phone:303-921-8947
Mailing Address - Fax:
Practice Address - Street 1:801 E 17TH AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1417
Practice Address - Country:US
Practice Address - Phone:303-921-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-21
Last Update Date:2017-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist