Individual
BREANA JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1738 N WATERMAN AVE STE 1, SAN BERNARDINO, CA 92404-5131
(909) 846-3507
Mailing address
1738 N WATERMAN AVE STE 1, SAN BERNARDINO, CA 92404-5131
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/12/2023
Last updated
01/17/2023
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