MEDICARE: MS. BREANNA CHAMPION-YBARRA RN, MSN, PHN

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	163W00000X	Registered Nurse	95096098	CA
2	163W00000X	Registered Nurse	274785	AZ

General Provider Information

NPI Number	:	1285430546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BREANNA CHAMPION-YBARRA RN, MSN, PHN

Provider Business Mailing Address
First Line	:	2618 SAN MIGUEL DR # 2044
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5437
Country	:	US
Telephone Number	:	888-569-1442
Fax Number	:

Provider Business Practice Location Address
First Line	:	2618 SAN MIGUEL DR # 2044
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5437
Country	:	US
Telephone Number	:	888-569-1442
Fax Number	:

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

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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