Provider Demographics
NPI:1912132598
Name:BREEDLOVE, DANITA JOY
Entity Type:Individual
Prefix:
First Name:DANITA
Middle Name:JOY
Last Name:BREEDLOVE
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 1:719 CORMORANT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1329
Mailing Address - Country:US
Mailing Address - Phone:210-675-0480
Mailing Address - Fax:210-675-0480
Practice Address - Street 1:719 CORMORANT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1329
Practice Address - Country:US
Practice Address - Phone:210-675-0480
Practice Address - Fax:210-675-0480
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health