Healthcare Provider Details

I. General information

NPI: 1245019652
Provider Name (Legal Business Name): BROOKE E TALENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 ROMER BLVD
POLLOCK PINES CA
95726-9242
US

IV. Provider business mailing address

2731 LA CRESCENTA DR APT 4
CAMERON PARK CA
95682-7928
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 916-757-2357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: