Healthcare Provider Details

I. General information

NPI: 1134015308
Provider Name (Legal Business Name): BREANNA SALAS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 LOCKHILL SELMA RD STE 102
SAN ANTONIO TX
78213-1559
US

IV. Provider business mailing address

1150 N LOOP 1604 W STE 108-411
SAN ANTONIO TX
78248-4552
US

V. Phone/Fax

Practice location:
  • Phone: 210-643-1119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: