MEDICARE: BREANNA VICTORIA SAN MIGUEL

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	:	1043158330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA VICTORIA SAN MIGUEL

Provider Business Mailing Address
First Line	:	7652 PICKERING AVE APT A
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90602-1507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 S FREMONT AVE
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-8800
Country	:	US
Telephone Number	:	626-349-3838
Fax Number	:

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

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/26/2026

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Directions to “ BREANNA VICTORIA SAN MIGUEL ” Practice Location

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