Healthcare Provider Details

I. General information

NPI: 1790489896
Provider Name (Legal Business Name): BRIZA CYNTHIA BROOKS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIZA CYNTHIA BROOKS OD

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E 2ND ST
POMONA CA
91766-2007
US

IV. Provider business mailing address

795 E 2ND ST
POMONA CA
91766-2007
US

V. Phone/Fax

Practice location:
  • Phone: 909-623-6116
  • Fax:
Mailing address:
  • Phone: 909-623-6116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number35314-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: