Healthcare Provider Details

I. General information

NPI: 1689392813
Provider Name (Legal Business Name): GUADALUPE BRAVO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5558 CALIFORNIA AVE
BAKERSFIELD CA
93309-0705
US

IV. Provider business mailing address

1063 MCGAW AVE STE 100
IRVINE CA
92614-5554
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-1577
  • Fax:
Mailing address:
  • Phone: 949-688-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: