Provider Demographics
NPI:1659267656
Name:BREDA, CARMEN
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:BREDA
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 1:3870 LA SIERRA AVE # 204
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3528
Mailing Address - Country:US
Mailing Address - Phone:951-729-6282
Mailing Address - Fax:
Practice Address - Street 1:11681 STERLING AVE STE I
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4972
Practice Address - Country:US
Practice Address - Phone:951-809-7084
Practice Address - Fax:951-809-7084
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker