Provider Demographics
NPI:1871804187
Name:BREITENBACH, EDWIN E (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:E
Last Name:BREITENBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 AUGUSTA
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1201
Mailing Address - Country:US
Mailing Address - Phone:714-730-0087
Mailing Address - Fax:
Practice Address - Street 1:2601 AUGUSTA
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1201
Practice Address - Country:US
Practice Address - Phone:714-730-0087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE16157207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery