Healthcare Provider Details

I. General information

NPI: 1043922099
Provider Name (Legal Business Name): BROOKE SCHMIDT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2022
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

901 E ALOSTA AVE
AZUSA CA
91702-2701
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-6411
  • Fax: 562-777-7510
Mailing address:
  • Phone: 310-634-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95088327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: