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General NPI Number Information
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NPI Number | 1659541027
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Entity Type | Individual
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Provider Name | BROOKE CAROLINE LEEDY PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/02/2008
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 751 W LEGION RD
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City | BRAWLEY
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State | CA
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Zip | 92227-7732
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Country | US
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Telephone | 760-351-2627
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 VALENCIA DR
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City | ESCONDIDO
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State | CA
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Zip | 92025-6735
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Country | US
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Telephone | 951-265-0672
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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 |
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License Number State |
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