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NPI Code Detail

MEDICARE: MRS. VANILLA P. BROOKS RNP

MEDICARE: MRS. VANILLA P. BROOKS RNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse Practitioner314197CA

General Provider Information

NPI Number : 1275691172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VANILLA P. BROOKS RNP
Provider Business Mailing Address
First Line : 250 TAHOE ST
Second Line :
City : PERRIS
State : CA
Zip : 92571-2795
Country : US
Telephone Number : 310-831-2490
Fax Number :
Provider Business Practice Location Address
First Line : 1009 N AVALON BLVD
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-4505
Country : US
Telephone Number : 310-549-5760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/08/2007

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