Provider Demographics
NPI:1588228241
Name:ADAME-RAMIREZ, BREANNA LYNN
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:LYNN
Last Name:ADAME-RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7140 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-3906
Mailing Address - Country:US
Mailing Address - Phone:951-333-2442
Mailing Address - Fax:
Practice Address - Street 1:7140 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3906
Practice Address - Country:US
Practice Address - Phone:951-333-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician