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NPI Code Detail

MEDICARE: IRENE MERRITT BROOKS RADT

MEDICARE: IRENE MERRITT BROOKS RADT
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1568924884
Entity Type Code : Individual
Provider Name (Legal Business Name) : IRENE MERRITT BROOKS RADT
Provider Business Mailing Address
First Line : 4610 MUIR AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92107-2248
Country : US
Telephone Number : 619-316-5084
Fax Number :
Provider Business Practice Location Address
First Line : 336 OXFORD ST STE 209
Second Line :
City : CHULA VISTA
State : CA
Zip : 91911-3122
Country : US
Telephone Number : 619-691-1662
Fax Number : 619-691-1663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2019
Last Update Date : 02/03/2022

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Directions to “ IRENE MERRITT BROOKS RADT” Practice Location

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