Healthcare Provider Details

I. General information

NPI: 1588584981
Provider Name (Legal Business Name): ROB EDWARD BREAZEALE CPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 MAIN ST
WEAVERVILLE CA
96093-1099
US

IV. Provider business mailing address

PO BOX 3231
WEAVERVILLE CA
96093-3231
US

V. Phone/Fax

Practice location:
  • Phone: 530-623-1822
  • Fax:
Mailing address:
  • Phone: 530-623-1822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: