Healthcare Provider Details

I. General information

NPI: 1174962054
Provider Name (Legal Business Name): SARAH ELIZABETH BROOME PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 MAIN ST
OAKLEY CA
94561-3302
US

IV. Provider business mailing address

4165 BLACKHAWK PLAZA CIR 100
DANVILLE CA
94506-4691
US

V. Phone/Fax

Practice location:
  • Phone: 925-776-8200
  • Fax: 925-776-8260
Mailing address:
  • Phone: 925-736-7070
  • Fax: 925-736-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22781
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: