Healthcare Provider Details

I. General information

NPI: 1700694924
Provider Name (Legal Business Name): LAURIE ANN BRETON PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURIE ANN CLARQUE PPS

II. Dates (important events)

Enumeration Date: 12/19/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 MARTEN AVE
SAN JOSE CA
95148-1300
US

IV. Provider business mailing address

3434 MARTEN AVE
SAN JOSE CA
95148-1300
US

V. Phone/Fax

Practice location:
  • Phone: 408-223-3740
  • Fax: 408-223-3742
Mailing address:
  • Phone: 408-223-3740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: