Provider Demographics
NPI:1447900683
Name:MELGOZA, BRADLEY D (NONE)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:D
Last Name:MELGOZA
Suffix:
Gender:M
Credentials:NONE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 E 46TH AVE STE 680
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-3158
Mailing Address - Country:US
Mailing Address - Phone:303-945-7063
Mailing Address - Fax:
Practice Address - Street 1:12015 E 46TH AVE STE 680
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-3158
Practice Address - Country:US
Practice Address - Phone:303-945-7063
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician