Healthcare Provider Details

I. General information

NPI: 1366782252
Provider Name (Legal Business Name): VANESSA BROOK TILP CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA BROOK AUDINO

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCLA OBGYN CONSULTATION SUITE 200 UCLA MEDICAL PLAZA SUITE 430
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

UCLA OBGYN CONSULTATION SUITE 200 UCLA MEDICAL PLAZA SUITE 430
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-4434
  • Fax:
Mailing address:
  • Phone: 310-794-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number637262
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1648
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number15443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: