Healthcare Provider Details

I. General information

NPI: 1649860115
Provider Name (Legal Business Name): OMAR J BREEDLOVE MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 10TH ST
SAN FRANCISCO CA
94103-2604
US

IV. Provider business mailing address

1360 MISSION ST FL 2
SAN FRANCISCO CA
94103-2647
US

V. Phone/Fax

Practice location:
  • Phone: 415-374-7854
  • Fax:
Mailing address:
  • Phone: 628-217-7464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-EQTMLB
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: