Provider Demographics
NPI:1689379232
Name:CASSOFF, BROOKE (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:CASSOFF
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12675 CAMINO MIRA DEL MAR UNIT 170
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2572
Mailing Address - Country:US
Mailing Address - Phone:412-760-7309
Mailing Address - Fax:
Practice Address - Street 1:12675 CAMINO MIRA DEL MAR UNIT 170
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2572
Practice Address - Country:US
Practice Address - Phone:412-760-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
1989OtherRISELY HEALTH