Healthcare Provider Details

I. General information

NPI: 1386976629
Provider Name (Legal Business Name): REBECCA MICHELLE BRESNYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N 9TH ST
MODESTO CA
95350-5814
US

IV. Provider business mailing address

500 N 9TH ST STE C
MODESTO CA
95350-5814
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-4420
  • Fax:
Mailing address:
  • Phone: 209-558-4420
  • Fax: 209-558-4873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: