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NPI Code Detail

MEDICARE: BREAWNA LANE

MEDICARE: BREAWNA LANE
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
1106H00000XMarriage & Family Therapist99754CA

General Provider Information

NPI Number : 1073038469
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREAWNA LANE
Provider Business Mailing Address
First Line : PO BOX 710145
Second Line :
City : SAN DIEGO
State : CA
Zip : 92171-0145
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4930 NAPLES ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-3820
Country : US
Telephone Number : 619-276-1176
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2017
Last Update Date : 02/04/2026

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Directions to “ BREAWNA LANE ” Practice Location

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