Healthcare Provider Details

I. General information

NPI: 1396400891
Provider Name (Legal Business Name): BREATHE CALIFORNIA OF THE BAY AREA, GOLDEN GATE, AND CENTRAL COAST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 10/10/2024
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 PARK AVE
SAN JOSE CA
95126-2530
US

IV. Provider business mailing address

1469 PARK AVE
SAN JOSE CA
95126-2530
US

V. Phone/Fax

Practice location:
  • Phone: 408-998-5865
  • Fax: 408-998-0578
Mailing address:
  • Phone: 408-998-5865
  • Fax: 408-998-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: TANYA PAYYAPPILLY
Title or Position: CEO
Credential:
Phone: 408-998-5865