Healthcare Provider Details

I. General information

NPI: 1760267868
Provider Name (Legal Business Name): BROOKE CISEWSKI RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18181 BUTTERFIELD BLVD STE 181
MORGAN HILL CA
95037-8108
US

IV. Provider business mailing address

2840 TOHARA WAY
MORGAN HILL CA
95037-9462
US

V. Phone/Fax

Practice location:
  • Phone: 408-659-1865
  • Fax:
Mailing address:
  • Phone: 408-763-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: