Healthcare Provider Details

I. General information

NPI: 1699602722
Provider Name (Legal Business Name): BREONA ROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2327 CULLEN CT APT B
BAKERSFIELD CA
93314-6584
US

IV. Provider business mailing address

2327 CULLEN CT APT B
BAKERSFIELD CA
93314-6584
US

V. Phone/Fax

Practice location:
  • Phone: 323-868-9654
  • Fax: 323-868-9654
Mailing address:
  • Phone: 323-868-9654
  • Fax: 323-868-9654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: