Healthcare Provider Details

I. General information

NPI: 1225890122
Provider Name (Legal Business Name): TIFFANY LEYLA BRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2024
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17822 BEACH BLVD STE 200
HUNTINGTON BEACH CA
92647-7190
US

IV. Provider business mailing address

17822 BEACH BLVD STE 200
HUNTINGTON BEACH CA
92647-7190
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax: 714-916-0000
Mailing address:
  • Phone: 714-545-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63967
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPA63967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: