Provider Demographics
NPI:1710745476
Name:BROOKS, DARRYL (HIS)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 WOODCREST LN
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-2124
Mailing Address - Country:US
Mailing Address - Phone:208-995-3489
Mailing Address - Fax:
Practice Address - Street 1:98 WOODCREST LN
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-2124
Practice Address - Country:US
Practice Address - Phone:208-995-3489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-10139017237600000X
HAS-P-10139017237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter