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General NPI Number Information
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NPI Number | 1619110335
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Entity Type | Individual
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Provider Name | BROOKE TRACY LEVERONE N.D.
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Gender | Female
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Dates
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Enumeration Date | 04/10/2009
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 5632 LA JOLLA BLVD
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City | LA JOLLA
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State | CA
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Zip | 92037-7523
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Country | US
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Telephone | 858-257-2808
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Fax | 858-459-0698
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Provider Business Mailing Address
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Address Line | 5632 LA JOLLA BLVD
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City | LA JOLLA
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State | CA
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Zip | 92037-7523
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Country | US
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Telephone | 858-257-2808
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Fax | 858-459-0698
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | ND449
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License Number State | CA
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