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LAURA BRECKENRIDGE NP
Sports Medicine >> Internal Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1013091594
Individual Registrant: LAURA BRECKENRIDGE NP
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
1001 SNEATH LN SUITE 104 SAN BRUNO, CA 94066-2308 US
Tel: 650-873-4545 Fax: 650-873-4544
Tel: 650-873-4545 Fax: 650-873-4544
Contact information for business:
308 22ND AVE SAN MATEO, CA 94403-1710 US
Tel: 650-357-7971 Fax: --
Tel: 650-357-7971 Fax: --
Registration Information:
NPI: 1013091594
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 207RS0010X | Allopathic & Osteopathic Physicians Internal Medicine Sports Medicine | CA | G64476 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 00G644760 | CA | 05 |
