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General NPI Number Information
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NPI Number | 1497394456
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Entity Type | Individual
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Provider Name | JOSHUA BRAVO BELTRAN DC
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Gender | Male
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Dates
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Enumeration Date | 12/22/2019
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Last Update Date | 12/22/2019
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Provider Practice Location Address
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Address Line | 210 W MAIN ST STE 102
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City | TUSTIN
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State | CA
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Zip | 92780-7701
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Country | US
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Telephone | 714-398-8524
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Fax |
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Provider Business Mailing Address
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Address Line | 432 W LINDEN DR
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City | ORANGE
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State | CA
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Zip | 92865-5004
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Country | US
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Telephone | 724-349-2462
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 34652
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 34652
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License Number State | CA
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