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General NPI Number Information
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NPI Number | 1487794525
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Entity Type | Individual
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Provider Name | MARTAY C BREEZE L.V.N.
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 255 S MARIPOSA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90004-5407
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Country | US
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Telephone | 213-639-2675
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Fax | 213-380-6434
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Provider Business Mailing Address
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Address Line | 2708 RUSTIC LN
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City | GLENDALE
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State | CA
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Zip | 91208-2230
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Country | US
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Telephone | 323-514-8191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN141711
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License Number State | CA
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