Provider Demographics
NPI:1588664817
Name:BREGER, BARBARA CAMILLE (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:CAMILLE
Last Name:BREGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9905 STELLBAR PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4645
Mailing Address - Country:US
Mailing Address - Phone:310-274-8725
Mailing Address - Fax:310-276-0163
Practice Address - Street 1:9905 STELLBAR PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4645
Practice Address - Country:US
Practice Address - Phone:310-274-8725
Practice Address - Fax:310-276-0163
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21132207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA21132OtherINSURERS AS BC, BS, ETC
CA00A21132Medicaid
CA00A21132Medicaid
CAA21132OtherINSURERS AS BC, BS, ETC