Healthcare Provider Details

I. General information

NPI: 1053143941
Provider Name (Legal Business Name): BRAVO HOLISTIC HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MARY E CLARK DR STE 8
HAMPSTEAD NH
03841-2288
US

IV. Provider business mailing address

6 MARY E CLARK DR STE 8
HAMPSTEAD NH
03841-2288
US

V. Phone/Fax

Practice location:
  • Phone: 978-999-2449
  • Fax: 603-489-2058
Mailing address:
  • Phone: 978-999-2449
  • Fax: 603-489-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: YESIKA BRAVO
Title or Position: OWNER/PROVIDER
Credential: LAC
Phone: 978-999-2449