Healthcare Provider Details

I. General information

NPI: 1801070883
Provider Name (Legal Business Name): AMELIA J BRECKENRIDGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 W VENTURA ST
FILLMORE CA
93015-1876
US

IV. Provider business mailing address

133 W SANTA CLARA ST
VENTURA CA
93001-2543
US

V. Phone/Fax

Practice location:
  • Phone: 805-524-2000
  • Fax: 805-524-8682
Mailing address:
  • Phone: 805-677-5312
  • Fax: 805-677-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42011
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number127903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: