Individual
BREANA TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14700 MANZANITA PARK RD., BEAUMONT, CA 92223
(951) 845-3155
Mailing address
9245 CARRARI CT, RANCHO CUCAMONGA, CA 91737-1524
(909) 641-0694
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/08/2018
Last updated
10/08/2018
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