Healthcare Provider Details

I. General information

NPI: 1780330167
Provider Name (Legal Business Name): SHELEIA JANICE BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 HARRISON ST APT 459
OAKLAND CA
94612-3938
US

IV. Provider business mailing address

280 17TH ST
OAKLAND CA
94612-4124
US

V. Phone/Fax

Practice location:
  • Phone: 240-353-4636
  • Fax:
Mailing address:
  • Phone: 510-238-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: