Healthcare Provider Details

I. General information

NPI: 1164886958
Provider Name (Legal Business Name): KATHLEEN MARY BREDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S SAN VICENTE BLVD STE 603
LOS ANGELES CA
90048-4178
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-4566
  • Fax:
Mailing address:
  • Phone: 310-423-4566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95007943
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberRN2268188
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: