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General NPI Number Information
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NPI Number | 1740322429
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Entity Type | Organization
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Legal Business Name | JILLIAN BROOKS
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 05/17/2011
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Provider Practice Location Address
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Address Line | 155 SOLANO ST
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City | CORNING
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State | CA
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Zip | 96021-3511
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Country | US
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Telephone | 530-824-9433
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Fax | 530-824-9497
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Provider Business Mailing Address
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Address Line | 1220 ALMOND AVE
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City | REDDING
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State | CA
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Zip | 96001-1308
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Country | US
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Telephone | 530-824-9433
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Fax | 530-824-9497
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Authorized Official
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Title or Position | OWNER/TECHNOLOGIST
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Name | MS. JILLIAN BROOKS
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Credential | CRT
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Telephone | 530-824-9433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 01732
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License Number State | CA
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