Healthcare Provider Details

I. General information

NPI: 1407793458
Provider Name (Legal Business Name): BROOKE ASHLEY DENNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 WINDSOR DR
SAN BERNARDINO CA
92404-5416
US

IV. Provider business mailing address

2910 N MT VIEW AVE
SAN BERNARDINO CA
92405-3536
US

V. Phone/Fax

Practice location:
  • Phone: 909-361-6470
  • Fax:
Mailing address:
  • Phone: 909-361-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: