MEDICARE: BREA PATTERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1003553116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREA PATTERSON

Provider Business Mailing Address
First Line	:	4312 LYNNANN DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1251
Country	:	US
Telephone Number	:	626-394-4554
Fax Number	:

Provider Business Practice Location Address
First Line	:	4312 LYNNANN DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-1251
Country	:	US
Telephone Number	:	626-394-4554
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	05/19/2022

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Directions to “ BREA PATTERSON ” Practice Location

Language	Start Address	Practice Location

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