Provider Demographics
NPI:1518118124
Name:BREIDENSTEIN, BRENDA (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:BREIDENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:GONZALEZ-ENGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9415 CAMPUS POINT DR STE 113
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0946
Mailing Address - Country:US
Mailing Address - Phone:858-534-7440
Mailing Address - Fax:858-534-5695
Practice Address - Street 1:9415 CAMPUS POINT DR STE 113
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0946
Practice Address - Country:US
Practice Address - Phone:858-534-7440
Practice Address - Fax:858-534-5695
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN13142390200000X
CAA121728207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program