Healthcare Provider Details

I. General information

NPI: 1497394456
Provider Name (Legal Business Name): JOSHUA BRAVO BELTRAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2019
Last Update Date: 12/22/2019
Certification Date: 12/22/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W MAIN ST STE 102
TUSTIN CA
92780-7701
US

IV. Provider business mailing address

432 W LINDEN DR
ORANGE CA
92865-5004
US

V. Phone/Fax

Practice location:
  • Phone: 714-398-8524
  • Fax:
Mailing address:
  • Phone: 724-349-2462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number34652
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number34652
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: