Healthcare Provider Details

I. General information

NPI: 1619110335
Provider Name (Legal Business Name): BROOKE TRACY LEVERONE N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5632 LA JOLLA BLVD
LA JOLLA CA
92037-7523
US

IV. Provider business mailing address

5632 LA JOLLA BLVD
LA JOLLA CA
92037-7523
US

V. Phone/Fax

Practice location:
  • Phone: 858-257-2808
  • Fax: 858-459-0698
Mailing address:
  • Phone: 858-257-2808
  • Fax: 858-459-0698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: