Healthcare Provider Details

I. General information

NPI: 1639964083
Provider Name (Legal Business Name): BREANNA ADKINS-HORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39830 PORTOLA AVE STE B
PALM DESERT CA
92260-0623
US

IV. Provider business mailing address

39830 PORTOLA AVE STE B
PALM DESERT CA
92260-0623
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-8500
  • Fax:
Mailing address:
  • Phone: 951-686-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-DUQPFZ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: