Provider Demographics
NPI:1215543491
Name:BREAZELL, LASHANETTE JEANEAN
Entity Type:Individual
Prefix:
First Name:LASHANETTE
Middle Name:JEANEAN
Last Name:BREAZELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WASHINGTON ST APT 37
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6143
Mailing Address - Country:US
Mailing Address - Phone:916-494-1683
Mailing Address - Fax:
Practice Address - Street 1:50 WASHINGTON ST APT 37
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6143
Practice Address - Country:US
Practice Address - Phone:916-494-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty