Healthcare Provider Details

I. General information

NPI: 1407599558
Provider Name (Legal Business Name): RACHEL BROOKE DDS, FACP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 W 34TH ST
LOS ANGELES CA
90089-0641
US

IV. Provider business mailing address

2000 MAIN ST APT 108
SANTA MONICA CA
90405-1062
US

V. Phone/Fax

Practice location:
  • Phone: 213-740-2800
  • Fax:
Mailing address:
  • Phone: 703-635-6632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDDS110296
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: