Individual
BRENDA LEE WAALKENS-BREEDLOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
22280 CITY CENTER DR APT 4225, HAYWARD, CA 94541-2814
(510) 397-8177
Mailing address
22280 CITY CENTER DR APT 4225, HAYWARD, CA 94541-2814
(510) 209-2159
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
23882
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23882
CAMTC
CA
Enumeration date
09/18/2020
Last updated
09/18/2020
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