Provider Demographics
NPI:1992028476
Name:CARO, BREANNA ELYSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BREANNA
Middle Name:ELYSE
Last Name:CARO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14302 PINEWOOD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6924
Mailing Address - Country:US
Mailing Address - Phone:714-325-1526
Mailing Address - Fax:
Practice Address - Street 1:710 N EUCLID ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4115
Practice Address - Country:US
Practice Address - Phone:714-517-2100
Practice Address - Fax:714-490-1973
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20874363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMP2128951OtherDEA