Healthcare Provider Details

I. General information

NPI: 1659367548
Provider Name (Legal Business Name): REBECCA MARIE BRETON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CAPITOLA RD
SANTA CRUZ CA
95062-2912
US

IV. Provider business mailing address

125 WATER ST STE A2
SANTA CRUZ CA
95060-2786
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3500
  • Fax:
Mailing address:
  • Phone: 831-427-3500
  • Fax: 831-427-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG76630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: