Healthcare Provider Details

I. General information

NPI: 1821921982
Provider Name (Legal Business Name): MAYRA PATRICIA BRETADO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S IMPERIAL AVE
EL CENTRO CA
92243-4242
US

IV. Provider business mailing address

5976 GREYVILLE PL
RANCHO CUCAMONGA CA
91739-2422
US

V. Phone/Fax

Practice location:
  • Phone: 760-890-6203
  • Fax:
Mailing address:
  • Phone: 909-730-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95039135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: