Healthcare Provider Details

I. General information

NPI: 1518872076
Provider Name (Legal Business Name): MAYRA BRETADO PSYCHIATRIC NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5976 GREYVILLE PL # 113
RANCHO CUCAMONGA CA
91739-2422
US

IV. Provider business mailing address

310 N INDIAN HILL BLVD # 113
CLAREMONT CA
91711-4611
US

V. Phone/Fax

Practice location:
  • Phone: 909-730-0224
  • 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 Number
License Number State

VIII. Authorized Official

Name: MAYRA BRETADO
Title or Position: PMHNP-BC
Credential: NP
Phone: 909-730-0224