MEDICARE: STEPHANIE DAWN BROOKS MS, RD, CEDRD

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	133V00000X	Registered Dietitian

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ24929Z	OTHER	CA	REGISTERED DIETITIAN

General Provider Information

NPI Number	:	1598889545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE DAWN BROOKS MS, RD, CEDRD

Provider Business Mailing Address
First Line	:	441 N CENTRAL AVE STE 2A
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-1428
Country	:	US
Telephone Number	:	408-370-7731
Fax Number	:	408-370-7732

Provider Business Practice Location Address
First Line	:	441 N CENTRAL AVE STE 2A
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-1428
Country	:	US
Telephone Number	:	408-370-7731
Fax Number	:	408-370-7732

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	05/25/2021

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