Healthcare Provider Details

I. General information

NPI: 1811827199
Provider Name (Legal Business Name): BROOKE BACKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24800 PEACHLAND AVE
NEWHALL CA
91321-3430
US

IV. Provider business mailing address

25431 VIA HERALDO
VALENCIA CA
91355-2715
US

V. Phone/Fax

Practice location:
  • Phone: 661-607-1827
  • Fax:
Mailing address:
  • Phone: 661-607-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number7040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: