Provider Demographics
NPI:1972117653
Name:BREKELMANS, VICTORIA ANN
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:BREKELMANS
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 1:1750 S MAIN ST SPC 84
Mailing Address - Street 2:
Mailing Address - City:WILLITS
Mailing Address - State:CA
Mailing Address - Zip Code:95490-4423
Mailing Address - Country:US
Mailing Address - Phone:707-972-9272
Mailing Address - Fax:
Practice Address - Street 1:776 S STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5847
Practice Address - Country:US
Practice Address - Phone:707-463-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program