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General NPI Number Information
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NPI Number | 1104524891
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Entity Type | Individual
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Provider Name | BROOKLYNE HAZENBERG PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/21/2023
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Last Update Date | 05/28/2023
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Provider Practice Location Address
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Address Line | 4171 OCEANSIDE BLVD STE 109
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City | OCEANSIDE
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State | CA
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Zip | 92056-6008
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Country | US
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Telephone | 760-216-6253
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Fax |
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Provider Business Mailing Address
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Address Line | 31775 NE WILSONVILLE RD
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City | NEWBERG
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State | OR
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Zip | 97132-7089
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Country | US
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Telephone | 503-899-7922
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA62332
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License Number State | CA
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