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NPI Code Detail

MEDICARE: BREONA GONZALEZ ALEXANDER CCC-SLP

MEDICARE: BREONA GONZALEZ ALEXANDER CCC-SLP
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
1235Z00000XSpeech-Language Pathologist37544CA
2235Z00000XSpeech-Language Pathologist6296SC

General Provider Information

NPI Number : 1164931499
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREONA GONZALEZ ALEXANDER CCC-SLP
Provider Business Mailing Address
First Line : 667 LIGHTHOUSE AVE STE 201
Second Line :
City : PACIFIC GROVE
State : CA
Zip : 93950-2666
Country : US
Telephone Number : 831-318-0558
Fax Number :
Provider Business Practice Location Address
First Line : 667 LIGHTHOUSE AVE STE 201
Second Line :
City : PACIFIC GROVE
State : CA
Zip : 93950-2666
Country : US
Telephone Number : 831-318-0558
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2017
Last Update Date : 10/23/2024

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Directions to “ BREONA GONZALEZ ALEXANDER CCC-SLP” Practice Location

Language Start Address Practice Location
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