Healthcare Provider Details

I. General information

NPI: 1063924470
Provider Name (Legal Business Name): BROOKS FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 W CHEYENNE AVE SUITE 100
NORTH LAS VEGAS NV
89032-8212
US

IV. Provider business mailing address

3670 N RANCHO DRIVE SUITE 106
LAS VEGAS NV
89130-3174
US

V. Phone/Fax

Practice location:
  • Phone: 702-570-5200
  • Fax: 702-570-5201
Mailing address:
  • Phone: 702-570-5200
  • Fax: 702-473-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DEVIN BROOKS
Title or Position: OWNER/CEO
Credential:
Phone: 702-910-5773