| Mark D Breithaupt Phd Inc | |
|
1100 Lincoln Ave Ste 394 San Jose CA 95125 | |
| (408) 320-2747 | |
| (408) 320-2747 |
| Full Name | Mark D Breithaupt Phd Inc |
|---|---|
| Speciality | Psychologist |
| Location | 1100 Lincoln Ave Ste 394, San Jose, California |
| Authorized Official Name and Position | Mark Douglas Breithaupt (LICENSED CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 4083202747 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark D Breithaupt Phd Inc Po Box 8396 San Jose CA 95155-8396 Ph: (408) 320-2747 | Mark D Breithaupt Phd Inc 1100 Lincoln Ave Ste 394 San Jose CA 95125 Ph: (408) 320-2747 |
| NPI Number | 1902115082 |
|---|---|
| Provider Enumeration Date | 10/06/2010 |
| Last Update Date | 09/09/2019 |
| Medicare PECOS PAC ID | 8123208618 |
|---|---|
| Medicare Enrollment ID | O20110216000359 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902115082 | NPI | - | NPPES |
| HMSA | Other | HI | HMSA |
| 03451701 | Medicaid | HI |
| Provider Name | Mark D Breithaupt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1053436337 PECOS PAC ID: 2264455120 Enrollment ID: I20060106000439 |
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