Provider Demographics
NPI:1194378075
Name:CULPEPPER, BREANNA MARIE
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:MARIE
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:MARIE
Other - Last Name:JASKOWIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10717 CAMINO RUIZ STE 207
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2364
Mailing Address - Country:US
Mailing Address - Phone:949-833-2237
Mailing Address - Fax:858-695-3521
Practice Address - Street 1:10717 CAMINO RUIZ STE 207
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2364
Practice Address - Country:US
Practice Address - Phone:949-833-2237
Practice Address - Fax:858-695-3521
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program