MEDICARE: BROOKE DEVLIN BA

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
1	171M00000X	Case Manager/Care Coordinator	D6069598	CA

General Provider Information

NPI Number	:	1275877953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE DEVLIN BA

Provider Business Mailing Address
First Line	:	1246 DAHLIA LOOP
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-5219
Country	:	US
Telephone Number	:	510-599-8722
Fax Number	:

Provider Business Practice Location Address
First Line	:	9015 MURRAY AVE
Second Line	:
City	:	GILROY
State	:	CA
Zip	:	95020-3617
Country	:	US
Telephone Number	:	408-847-6087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	10/02/2013

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