MEDICARE: BROOKLYN WILSON ATC

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1871202721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLYN WILSON ATC

Provider Business Mailing Address
First Line	:	1333 COLORADO AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1523
Country	:	US
Telephone Number	:	909-855-8423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 COLORADO AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1523
Country	:	US
Telephone Number	:	909-855-8423
Fax Number	:

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

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	11/18/2022

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1861006223 — MS. MONSHITA MCDONALD FNP
Practice Location Address:

1523 SAN BERNARDINO WAY
VALDOSTA, GA
31601-2511

Practice Phone: 229-942-9618
Practice Fax:

1336901461 — BRANDI PEREZ M.S., CCC-SLP
Practice Location Address:

330 N D ST STE 304
SAN BERNARDINO, CA
92401-1523

Practice Phone: 760-600-5811
Practice Fax:

1316590078 — BRIAN MOZAFFARI M.D., INC.
Practice Location Address:

1640 CAMINO DEL RIO N , STE 202 #880267
SAN DIEGO, CA
92108-1523

Practice Phone: 858-754-8833
Practice Fax:

1750381638 — DR. RUBINA KHILNANI MD
Practice Location Address:

1 BAYWOOD AVE , SUITE 9
SAN MATEO, CA
94402-1523

Practice Phone: 650-477-8112
Practice Fax: 650-401-8200

1215921424 — JOHN POWELL RUTHERGLEN PT
Practice Location Address:

1 BAYWOOD AVE , SUITE 1
SAN MATEO, CA
94402-1523

Practice Phone: 650-348-9400
Practice Fax: 650-348-9402

Directions to “ BROOKLYN WILSON ATC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.