Healthcare Provider Details

I. General information

NPI: 1316341118
Provider Name (Legal Business Name): BRANDI ROCHELLE BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 06/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3281 N DECATUR BLVD 280
LAS VEGAS NV
89130-3263
US

IV. Provider business mailing address

5576 CY YOUNG DR
LAS VEGAS NV
89110-5621
US

V. Phone/Fax

Practice location:
  • Phone: 702-444-6082
  • Fax: 702-650-2184
Mailing address:
  • Phone: 702-722-2495
  • Fax: 702-650-2184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: