Healthcare Provider Details

I. General information

NPI: 1487340568
Provider Name (Legal Business Name): JEAN PIERRE BRAVO LMFT 140241
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 ALCOSTA BLVD BLDG A
SAN RAMON CA
94583-4134
US

IV. Provider business mailing address

1 SANSOME ST STE 1400
SAN FRANCISCO CA
94104-4431
US

V. Phone/Fax

Practice location:
  • Phone: 415-513-4350
  • Fax:
Mailing address:
  • Phone: 661-932-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: