Provider Demographics
NPI:1427372606
Name:BREIDEN, CRYSTAL LEIGH (PA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEIGH
Last Name:BREIDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 DELAWARE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1959
Mailing Address - Country:US
Mailing Address - Phone:714-848-0090
Mailing Address - Fax:
Practice Address - Street 1:18800 DELAWARE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1959
Practice Address - Country:US
Practice Address - Phone:714-848-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20716363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant