Provider Demographics
NPI:1457817827
Name:BROOME, RHAYVEN L
Entity Type:Individual
Prefix:
First Name:RHAYVEN
Middle Name:L
Last Name:BROOME
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 1:7891 MISSION GROVE PKWY S
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5056
Mailing Address - Country:US
Mailing Address - Phone:951-776-9223
Mailing Address - Fax:
Practice Address - Street 1:7899 MISSION GROVE PKWY S STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5062
Practice Address - Country:US
Practice Address - Phone:951-776-9223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X
CASZUIMT175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker