Healthcare Provider Details

I. General information

NPI: 1225532039
Provider Name (Legal Business Name): BROOKE TOWNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 VISTA WAY 108
OCEANSIDE CA
92056
US

IV. Provider business mailing address

477 N EL CAMINO REAL B301
ENCINITAS CA
92024-1331
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-7336
  • Fax: 760-943-6494
Mailing address:
  • Phone: 760-753-1104
  • Fax: 760-943-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA165577
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberA165577
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: