Healthcare Provider Details

I. General information

NPI: 1437046588
Provider Name (Legal Business Name): BROOKE COLLINS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49467 CONEJO RD
MORONGO VALLEY CA
92256-9701
US

IV. Provider business mailing address

49467 CONEJO RD
MORONGO VALLEY CA
92256-9701
US

V. Phone/Fax

Practice location:
  • Phone: 760-861-1577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: