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General NPI Number Information
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NPI Number | 1669478228
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Entity Type | Organization
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Legal Business Name | IVAN L BREED MD INC
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Dates
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Enumeration Date | 06/28/2005
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Last Update Date | 04/11/2013
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Provider Practice Location Address
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Address Line | 605 E BADILLO ST SUITE 110
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City | COVINA
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State | CA
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Zip | 91723-2846
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Country | US
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Telephone | 626-917-5999
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Fax | 626-917-5999
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Provider Business Mailing Address
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Address Line | PO BOX 4609
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City | COVINA
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State | CA
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Zip | 91723-4609
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Country | US
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Telephone | 626-917-5999
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Fax | 626-917-5999
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | IVAN L BREED
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Credential | MD
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Telephone | 626-917-5999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A31294
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License Number State | CA
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