Provider Demographics
NPI:1184961716
Name:BRAVO ONE, INC.
Entity type:Organization
Organization Name:BRAVO ONE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:916-772-4327
Mailing Address - Street 1:9700 FAIRWAY DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3604
Mailing Address - Country:US
Mailing Address - Phone:916-772-4327
Mailing Address - Fax:916-772-4328
Practice Address - Street 1:9700 FAIRWAY DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3604
Practice Address - Country:US
Practice Address - Phone:916-772-4327
Practice Address - Fax:916-772-4328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA4140237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty