Healthcare Provider Details

I. General information

NPI: 1467817783
Provider Name (Legal Business Name): DANA LLAMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA BREWER

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 04/14/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 BROCKTON AVE FL 2
RIVERSIDE CA
92506-2614
US

IV. Provider business mailing address

7160 BROCKTON AVE FL 2
RIVERSIDE CA
92506-2614
US

V. Phone/Fax

Practice location:
  • Phone: 951-782-3837
  • Fax:
Mailing address:
  • Phone: 951-782-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: