Active NPI
Breanna Louise Potenciano
- Physician Assistant
- Loma Linda, CA
National Provider Identifier
1255293379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA67865
- Practice address
- 24951 Circle Dr Ste 1605
Loma Linda, CA 92350-1718 - Phone
- (909) 558-4599
- NPI assigned
- Nov 26, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA67865 | CA | Primary |
Addresses
Primary practice location
24951 Circle Dr Ste 1605
Loma Linda, CA 92350-1718
Mailing address
24951 Circle Dr Ste 1605
Loma Linda, CA 92350-1718
Phone (909) 558-4599
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA67865 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1764115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1771632000000",
"number": "1255293379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24951 CIRCLE DR STE 1605",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923501718",
"telephone_number": "909-558-4599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24951 CIRCLE DR STE 1605",
"city": "LOMA LINDA",
"state": "CA",
"postal_code": "923501718",
"telephone_number": "909-558-4599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTENCIANO",
"first_name": "BREANNA",
"middle_name": "LOUISE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-11-26",
"last_updated": "2026-02-21",
"certification_date": "2026-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA67865",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loma Linda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.