Healthcare Provider Details

I. General information

NPI: 1275933483
Provider Name (Legal Business Name): CHRISTI BROOKS M.S, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 E SPRING ST
ORANGE CA
92869-3414
US

IV. Provider business mailing address

3920 E SPRING ST
ORANGE CA
92869-3414
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-6331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000016735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: