Provider Demographics
NPI:1598889545
Name:BROOKS, STEPHANIE DAWN (MS, RD, CEDRD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DAWN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS, RD, CEDRD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 N CENTRAL AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1428
Mailing Address - Country:US
Mailing Address - Phone:408-370-7731
Mailing Address - Fax:408-370-7732
Practice Address - Street 1:441 N CENTRAL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1428
Practice Address - Country:US
Practice Address - Phone:408-370-7731
Practice Address - Fax:408-370-7732
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24929ZOtherREGISTERED DIETITIAN