1841453651 NPI number — SYLVESTER B BROOKS CAS#6818

Table of content: SYLVESTER B BROOKS CAS#6818 (NPI 1841453651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841453651 NPI number — SYLVESTER B BROOKS CAS#6818

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
SYLVESTER
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CAS#6818
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841453651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10700 MACARTHUR BLVD STE 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94605-5260
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-568-2432
Provider Business Mailing Address Fax Number:
510-568-3912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10700 MACARTHUR BLVD STE 12
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94605-5260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-568-2432
Provider Business Practice Location Address Fax Number:
510-568-3912
Provider Enumeration Date:
07/02/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  CAS 6818 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 941702064 . This is a "ALCOHOL AND DRUG" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".