Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | GFE16157 | CA |
NPI | 1871804187 |
---|---|
Provider Name | Dr. Edwin E Breitenbach |
First Address | Tustin, CA 92782-1201 |
Second Address | Tustin, CA 92782-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 01/07/2010 |