Most Relevant Information
Provider Data
| NPI Number: | 1003596917 |
| Provider Name: | BREANNA HEREDIA |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/25/2023 |
| Last Updated: | 07/25/2023 |
Provider Practice Location
32326 CLINTON KEITH RD STE 201
WILDOMAR
CA
925957317
Practice Location Phone/Fax
| Phone: | 8582645858 |
| Fax: | 8586496012 |
Provider Mailing Location
32326 CLINTON KEITH RD STE 201
WILDOMAR
CA
925957317
Provider Mailing Phone/Fax
| Phone: | 8582645858 |
| Fax: | 8586496012 |