MEDICARE: YULIA BROKKEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1063838670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YULIA BROKKEN

Provider Business Mailing Address
First Line	:	3575 CAMINITO EL RINCON UNIT 214
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3522
Country	:	US
Telephone Number	:	185-834-2311
Fax Number	:

Provider Business Practice Location Address
First Line	:	3575 CAMINITO EL RINCON UNIT 214
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-3522
Country	:	US
Telephone Number	:	858-342-3118
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2014
Last Update Date	:	03/11/2014

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Directions to “ YULIA BROKKEN ” Practice Location

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