Provider Demographics
NPI:1114173937
Name:BROUHA, BROOK L (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:BROOK
Middle Name:L
Last Name:BROUHA
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:7300 GIRARD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5138
Practice Address - Country:US
Practice Address - Phone:858-750-2983
Practice Address - Fax:858-750-2984
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA97902207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADL390ZOtherMEDICARE PTAN