Individual
LAURA BRECKENRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1001 SNEATH LN, SUITE 104, SAN BRUNO, CA 94066-2308
(650) 873-4545
(650) 873-4544
Mailing address
308 22ND AVE, SAN MATEO, CA 94403-1710
(650) 357-7971
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
G64476
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G644760
—
CA
Enumeration date
10/24/2006
Last updated
07/08/2007
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