MEDICARE: MRS. BROOKE HORN DEKOFSKY M.P.H, R.D., C.D.E

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	133V00000X	Registered Dietitian	1000842	CA

General Provider Information

NPI Number	:	1487953584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BROOKE HORN DEKOFSKY M.P.H, R.D., C.D.E

Provider Business Mailing Address
First Line	:	3188 S BENTLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3008
Country	:	US
Telephone Number	:	818-307-1541
Fax Number	:

Provider Business Practice Location Address
First Line	:	3188 S BENTLEY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3008
Country	:	US
Telephone Number	:	818-307-1541
Fax Number	:

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

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	04/28/2017

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