Healthcare Provider Details

I. General information

NPI: 1578441440
Provider Name (Legal Business Name): BREANNA WHITLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28999 OLD TOWN FRONT ST
TEMECULA CA
92590-5805
US

IV. Provider business mailing address

1260 E ARROW HWY
UPLAND CA
91786-4982
US

V. Phone/Fax

Practice location:
  • Phone: 888-255-9280
  • Fax:
Mailing address:
  • Phone: 909-932-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: