1871583682 NPI number — DR. DARRELL BROOKS MD

Table of content: DR. DARRELL BROOKS MD (NPI 1871583682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871583682 NPI number — DR. DARRELL BROOKS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKS
Provider First Name:
DARRELL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1871583682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 620807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94062-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-714-2091
Provider Business Mailing Address Fax Number:
208-330-5801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 WEBSTER ST
Provider Second Line Business Practice Location Address:
SUITE # 117
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94115-2373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-923-3340
Provider Business Practice Location Address Fax Number:
208-330-5801
Provider Enumeration Date:
10/24/2005

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: 2086S0122X , with the licence number:  G81805 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2082S0105X , with the licence number: G81805 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00G818050 . This is a "BS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G818050 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".