Healthcare Provider Details

I. General information

NPI: 1467682013
Provider Name (Legal Business Name): BYRON BROOKS MHRS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2009
Last Update Date: 07/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 COUNTY FARM RD
RIVERSIDE CA
92503-3507
US

IV. Provider business mailing address

2191 BUCKSKIN PL
RIVERSIDE CA
92506-4608
US

V. Phone/Fax

Practice location:
  • Phone: 951-343-2536
  • Fax: 951-729-3309
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: