Doctor Name: | MR. MATTHEW JOEL BROOKS |
NPI Number: | 1306159918 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP |
License Number: | 19992 |
Business Practice Address: | 3680 Industrial Blvd Suite 550-h West Sacramento, CA - 956916500 |
Business Phone Number: | 9163737575 |
Business Fax Number: | 9163731555 |
Mailing Address: | 3680 Industrial Blvd, Suite 550-h WEST SACRAMENTO |
State: | CA |
Postal Code: | 956916500 |
Phone Number: | 9163737575 |
Fax Number: | 9163731555 |
NPI Enumeration Date: | 07/24/2010 |
NPI Last Update Date: | 12/29/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 19992 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |