Provider Demographics
NPI:1346970233
Name:SVOBODA, PAUL BRENDT (LMT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BRENDT
Last Name:SVOBODA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33003 CHRISTINA DR
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-1009
Mailing Address - Country:US
Mailing Address - Phone:310-387-2560
Mailing Address - Fax:
Practice Address - Street 1:33003 CHRISTINA DR
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-1009
Practice Address - Country:US
Practice Address - Phone:310-387-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty