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General NPI Number Information
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NPI Number | 1184961716
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Entity Type | Organization
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Legal Business Name | BRAVO ONE, INC.
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Dates
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Enumeration Date | 01/16/2013
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 9700 FAIRWAY DR SUITE 120
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City | ROSEVILLE
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State | CA
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Zip | 95678-3604
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Country | US
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Telephone | 916-772-4327
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Fax | 916-772-4328
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Provider Business Mailing Address
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Address Line | 9700 FAIRWAY DR SUITE 120
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City | ROSEVILLE
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State | CA
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Zip | 95678-3604
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Country | US
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Telephone | 916-772-4327
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Fax | 916-772-4328
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERIC CHRISTOPHER BRADLEY
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Credential | HIS
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Telephone | 916-772-4327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HA4140
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License Number State | CA
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