1447081534 NPI number — BREANN LOPRESTO BS, BHT

Table of content: BREANN LOPRESTO BS, BHT (NPI 1447081534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447081534 NPI number — BREANN LOPRESTO BS, BHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPRESTO
Provider First Name:
BREANN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BS, BHT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447081534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17505 N 79TH AVE STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-8724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-989-8899
Provider Business Mailing Address Fax Number:
602-900-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17505 N 79TH AVE STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-8724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-989-8899
Provider Business Practice Location Address Fax Number:
602-900-0969
Provider Enumeration Date:
08/09/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  BSBHT , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 203827 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125011 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1740851542 . This is a "JANUARY HARTZE INDIVIDUAL NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1043982747 . This is a "HEALING HARTZE ORGANIZATION NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".