Provider Demographics
NPI:1881386746
Name:BREA, DANA RUTH (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:RUTH
Last Name:BREA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 17TH ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5542
Mailing Address - Country:US
Mailing Address - Phone:310-633-0259
Mailing Address - Fax:
Practice Address - Street 1:1118 17TH ST APT 5
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5542
Practice Address - Country:US
Practice Address - Phone:310-633-0259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA823969163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient