Healthcare Provider Details

I. General information

NPI: 1871462937
Provider Name (Legal Business Name): BROOKE POLON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 E EARLL DR
SCOTTSDALE AZ
85251-6915
US

IV. Provider business mailing address

2035 S ELM ST UNIT 147
TEMPE AZ
85282-2668
US

V. Phone/Fax

Practice location:
  • Phone: 480-448-7500
  • Fax:
Mailing address:
  • Phone: 330-978-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number86415437
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: