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General NPI Number Information
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NPI Number | 1548480791
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Entity Type | Individual
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Provider Name | RAFAELE CAMILLE DESIRE BROOKS DDS
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Gender | Female
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 11633 HAWTHORNE BLVD #500
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City | HAWTHORNE
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State | CA
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Zip | 90250
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Country | US
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Telephone | 310-644-4412
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Fax | 310-644-7355
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Provider Business Mailing Address
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Address Line | 2554 LINCOLN BLVD #743
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City | VENICE
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State | CA
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Zip | 90291
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Country | US
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Telephone | 310-822-6518
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Fax | 310-822-6518
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 42300
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License Number State | CA
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