MEDICARE: WILLIAM BREVARD III

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	48803	CA

General Provider Information

NPI Number	:	1124626916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM BREVARD III

Provider Business Mailing Address
First Line	:	1645 W PALM LN APT 32
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92802-2022
Country	:	US
Telephone Number	:	714-926-2370
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 W PALM LN APT 32
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92802-2022
Country	:	US
Telephone Number	:	714-926-2370
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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Directions to “ WILLIAM BREVARD III ” Practice Location

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