Provider Demographics
NPI:1437366002
Name:REYNOLDS, BROOKE LEANN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:LEANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7392 MAGNOLIA AVE
Mailing Address - Street 2:#2711
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504
Mailing Address - Country:US
Mailing Address - Phone:951-352-3330
Mailing Address - Fax:951-352-3303
Practice Address - Street 1:7392 MAGNOLIA AVE
Practice Address - Street 2:#2711
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504
Practice Address - Country:US
Practice Address - Phone:951-352-3330
Practice Address - Fax:951-352-3303
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant