Healthcare Provider Details

I. General information

NPI: 1255083598
Provider Name (Legal Business Name): BROOKE MCDONALD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 COLLEGE AVE
BAKERSFIELD CA
93305-4113
US

IV. Provider business mailing address

2151 COLLEGE AVE
BAKERSFIELD CA
93305-4113
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: FERNANDA RAMIREZ
Title or Position: SUPERVISOR
Credential:
Phone: 661-868-8156