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NPI Code Detail

MEDICARE: KEITH R BROOKENTHAL MD

MEDICARE: KEITH R BROOKENTHAL MD
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
1207X00000XOrthopaedic Surgery PhysicianA79821CA

General Provider Information

NPI Number : 1437118163
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH R BROOKENTHAL MD
Provider Business Mailing Address
First Line : 24712 HERMOSILLA COURT
Second Line :
City : CALABASAS
State : CA
Zip : 91302
Country : US
Telephone Number : 818-223-9568
Fax Number :
Provider Business Practice Location Address
First Line : 5353 BALBOA BLVD
Second Line : SUITE 202
City : ENCINO
State : CA
Zip : 91316-2804
Country : US
Telephone Number : 818-789-9449
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 06/03/2008

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Directions to “ KEITH R BROOKENTHAL MD” Practice Location

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