Provider Demographics
NPI:1164565339
Name:SATEESH, BROOKE RESH (MD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:RESH
Last Name:SATEESH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:FAYE
Other - Last Name:RESH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:655 EUCLID AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2978
Mailing Address - Country:US
Mailing Address - Phone:619-267-8303
Mailing Address - Fax:619-267-4835
Practice Address - Street 1:655 EUCLID AVE STE 401
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2978
Practice Address - Country:US
Practice Address - Phone:619-267-8303
Practice Address - Fax:619-267-4835
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA109670207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC115ZOtherMEDICARE PTAN