Most Relevant Information
Provider Data
| NPI Number: | 1003583261 |
| Provider Name: | BREANNE NICOLE SELF |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/25/2021 |
| Last Updated: | 08/25/2021 |
Provider Practice Location
11770 BERNARDO PLAZA CT STE 350
SAN DIEGO
CA
921282426
Practice Location Phone/Fax
| Phone: | 8182416780 |
| Fax: |
Provider Mailing Location
1055 E COLORADO BLVD STE 560
PASADENA
CA
911062380
Provider Mailing Phone/Fax
| Phone: | 8182416780 |
| Fax: | 8182416853 |