Provider Demographics
NPI:1811027048
Name:CAMPBELL, BROOKE NICOLE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3807 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6301
Mailing Address - Country:US
Mailing Address - Phone:781-264-6536
Mailing Address - Fax:
Practice Address - Street 1:1124 BAY BLVD STE D
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-7155
Practice Address - Country:US
Practice Address - Phone:619-420-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator