Provider Demographics
NPI:1154170702
Name:MOTA, BREEANNA N
Entity type:Individual
Prefix:MRS
First Name:BREEANNA
Middle Name:N
Last Name:MOTA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BREEANNA
Other - Middle Name:N
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2040 COLUMBIA ST APT 524
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8406
Mailing Address - Country:US
Mailing Address - Phone:619-823-8253
Mailing Address - Fax:
Practice Address - Street 1:1771 E FLAMINGO RD STE 220A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0850
Practice Address - Country:US
Practice Address - Phone:702-369-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician