Provider Demographics
NPI:1477960029
Name:BROOKS, KATHERINE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:RHODES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:805 PASEO CAMARILLO
Mailing Address - Street 2:#530
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-0889
Mailing Address - Country:US
Mailing Address - Phone:805-298-2228
Mailing Address - Fax:
Practice Address - Street 1:805 PASEO CAMARILLO
Practice Address - Street 2:#530
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-0889
Practice Address - Country:US
Practice Address - Phone:805-298-2228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program