MEDICARE: VICTORIA BROACH

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	106H00000X	Marriage & Family Therapist	159685	CA

General Provider Information

NPI Number	:	1326700220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA BROACH

Provider Business Mailing Address
First Line	:	PO BOX 2561
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-5561
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 E 12TH ST
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-3424
Country	:	US
Telephone Number	:	510-269-9030
Fax Number	:

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

Provider Enumeration Date	:	10/07/2021
Last Update Date	:	01/08/2026

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Directions to “ VICTORIA BROACH ” Practice Location

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