Individual
BREANNA BEAVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
209 E 7TH ST, MADERA, CA 93638-3780
(559) 673-3508
Mailing address
PO BOX 1288, MADERA, CA 93639-1288
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/10/2019
Last updated
04/10/2019
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