Provider Demographics
NPI:1588661193
Name:BROCKETT, KATHY W (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:W
Last Name:BROCKETT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:27867 SMYTH DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4011
Mailing Address - Country:US
Mailing Address - Phone:661-294-2229
Mailing Address - Fax:661-294-8399
Practice Address - Street 1:27867 SMYTH DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4011
Practice Address - Country:US
Practice Address - Phone:661-294-2229
Practice Address - Fax:661-294-8399
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG553262080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine