Individual
CHARNELLE BREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2720 E PALMDALE BLVD STE 129, PALMDALE, CA 93550-4930
(661) 947-3333
Mailing address
2720 E PALMDALE BLVD STE 129, PALMDALE, CA 93550-4930
(661) 947-3333
(661) 575-2397
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
220964
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B7186314
—
CA
Enumeration date
12/23/2020
Last updated
12/23/2020
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