Individual
JESSE BRAVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5018 ARROYO CHAMISA RD NE, ALBUQUERQUE, NM 87111-3720
(505) 489-3621
Mailing address
5018 ARROYO CHAMISA RD NE, ALBUQUERQUE, NM 87111-3720
(505) 489-3621
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/28/2019
Last updated
06/28/2019
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