MEDICARE: NAOMI LEAH BRECKON MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	A184063	CA

General Provider Information

NPI Number	:	1407475395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAOMI LEAH BRECKON MD

Provider Business Mailing Address
First Line	:	911 MORAGA RD STE 101
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4591
Country	:	US
Telephone Number	:	925-444-7073
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 MORAGA RD STE 101
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-4591
Country	:	US
Telephone Number	:	925-444-7073
Fax Number	:

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

Provider Enumeration Date	:	04/11/2020
Last Update Date	:	09/13/2023

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