Provider Demographics
NPI:1205104726
Name:BREID, MONA RAE (NP-C)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:RAE
Last Name:BREID
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38718 CELITA CIR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8576
Mailing Address - Country:US
Mailing Address - Phone:951-775-0803
Mailing Address - Fax:
Practice Address - Street 1:24910 LAS BRISAS RD STE 106
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-4010
Practice Address - Country:US
Practice Address - Phone:888-380-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF0911050363LF0000X
CA264649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily