Basic Information
| Provider Information | |||||||||
| NPI: | 1518118124 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREIDENSTEIN | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GONZALEZ-ENGLE | ||||||||
| OtherFirstName: | BRENDA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9415 CAMPUS POINT DR STE 113 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920930946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585347440 | ||||||||
| FaxNumber: | 8585345695 | ||||||||
| Practice Location | |||||||||
| Address1: | 9415 CAMPUS POINT DR STE 113 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920930946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585347440 | ||||||||
| FaxNumber: | 8585345695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2008 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TRN13142 | FL | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207W00000X | A121728 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.