Healthcare Provider Details

I. General information

NPI: 1295296150
Provider Name (Legal Business Name): TRENT ROCKNE BROOKSHIER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3989 32ND ST
SAN DIEGO CA
92104-2001
US

IV. Provider business mailing address

3989 32ND ST
SAN DIEGO CA
92104-2001
US

V. Phone/Fax

Practice location:
  • Phone: 619-283-2097
  • Fax:
Mailing address:
  • Phone: 619-283-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: