Healthcare Provider Details

I. General information

NPI: 1083110456
Provider Name (Legal Business Name): BROOKE HARMSSEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 EAST CHEVY CHASE DRIVE SUITE 355
GLENDALE CA
91206-4159
US

IV. Provider business mailing address

1650 EAST CHEVY CHASE DRIVE SUITE 355
GLENDALE CA
91206-4159
US

V. Phone/Fax

Practice location:
  • Phone: 747-212-3441
  • Fax: 747-273-0965
Mailing address:
  • Phone: 747-212-3441
  • Fax: 747-273-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA17897
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A17897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: