1548419609 NPI number — DR. KENNETH EUGENE BREEDING PH.D., MFT

Table of content: DR. KENNETH EUGENE BREEDING PH.D., MFT (NPI 1548419609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548419609 NPI number — DR. KENNETH EUGENE BREEDING PH.D., MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREEDING
Provider First Name:
KENNETH
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., MFT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548419609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4314 STANFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92010-7922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-434-2423
Provider Business Mailing Address Fax Number:
760-434-9482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3150 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-434-2423
Provider Business Practice Location Address Fax Number:
760-434-9482
Provider Enumeration Date:
09/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 22083 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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