Healthcare Provider Details

I. General information

NPI: 1407793045
Provider Name (Legal Business Name): DEVONTE BROOKS PSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 S SAN PEDRO ST
LOS ANGELES CA
90013-2119
US

IV. Provider business mailing address

12070 TELEGRAPH RD
SANTA FE SPRINGS CA
90670-3771
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-6411
  • Fax:
Mailing address:
  • Phone: 626-399-4854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-HNVTWS
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: