Provider Demographics
NPI:1003708447
Name:BRAVO, ALICIA ARCE (PPS)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ARCE
Last Name:BRAVO
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-1327
Mailing Address - Country:US
Mailing Address - Phone:760-234-8012
Mailing Address - Fax:
Practice Address - Street 1:670 FLOWER ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1327
Practice Address - Country:US
Practice Address - Phone:760-234-8012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210115226101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool