MEDICARE: BROOKE LANDRY PA-C

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	363A00000X	Physician Assistant	PA66931	CA

General Provider Information

NPI Number	:	1841077542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE LANDRY PA-C

Provider Business Mailing Address
First Line	:	3998 VISTA WAY STE 202
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4518
Country	:	US
Telephone Number	:	760-736-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	3998 VISTA WAY STE 202
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4518
Country	:	US
Telephone Number	:	760-736-6767
Fax Number	:

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

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	12/15/2025

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Directions to “ BROOKE LANDRY PA-C” Practice Location

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