1568084838 NPI number — ANASTASIA MARIE BRESHEARS CPHT

Table of content: ANASTASIA MARIE BRESHEARS CPHT (NPI 1568084838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568084838 NPI number — ANASTASIA MARIE BRESHEARS CPHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRESHEARS
Provider First Name:
ANASTASIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CANTERBURY
Provider Other First Name:
ANASTASIA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPHT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1568084838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5020 BOWMAN OAKS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMICHAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95608-3132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-289-8820
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4005 MANZANITA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608-1770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-483-2695
Provider Business Practice Location Address Fax Number:
916-483-4158
Provider Enumeration Date:
05/10/2020

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: 183700000X , with the licence number:  141705 , 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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