Provider Demographics
NPI:1063838670
Name:BROKKEN, YULIA
Entity Type:Individual
Prefix:
First Name:YULIA
Middle Name:
Last Name:BROKKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 CAMINITO EL RINCON UNIT 214
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3522
Mailing Address - Country:US
Mailing Address - Phone:185-834-2311
Mailing Address - Fax:
Practice Address - Street 1:3575 CAMINITO EL RINCON UNIT 214
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3522
Practice Address - Country:US
Practice Address - Phone:858-342-3118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist