Basic Information
| Provider Information | |||||||||
| NPI: | 1295288710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCAIN | ||||||||
| FirstName: | BREEANN | ||||||||
| MiddleName: | SUMMER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TOMPKINS | ||||||||
| OtherFirstName: | BREEANN | ||||||||
| OtherMiddleName: | SUMMER | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 41951 REMINGTON AVE | ||||||||
| Address2: | STE 210 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925902552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518134034 | ||||||||
| FaxNumber: | 9518134035 | ||||||||
| Practice Location | |||||||||
| Address1: | 41951 REMINGTON AVE | ||||||||
| Address2: | STE 210 | ||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925902552 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9518134034 | ||||||||
| FaxNumber: | 9518134035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2016 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.