Provider Demographics
NPI:1457810418
Name:BRAVO, BRIANDA ELENA
Entity Type:Individual
Prefix:
First Name:BRIANDA
Middle Name:ELENA
Last Name:BRAVO
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 1:13943 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-2442
Mailing Address - Country:US
Mailing Address - Phone:626-893-3170
Mailing Address - Fax:
Practice Address - Street 1:13941 OLIVE ST
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-2442
Practice Address - Country:US
Practice Address - Phone:626-893-3170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician