Provider Demographics
NPI:1922624592
Name:BROOKES PEDIATRICS LLC
Entity Type:Organization
Organization Name:BROOKES PEDIATRICS LLC
Other - Org Name:WEST SIDE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-821-2000
Mailing Address - Street 1:8440 W LAKE MEAD BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7648
Mailing Address - Country:US
Mailing Address - Phone:702-821-2000
Mailing Address - Fax:702-664-0482
Practice Address - Street 1:8440 W LAKE MEAD BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7648
Practice Address - Country:US
Practice Address - Phone:702-821-2000
Practice Address - Fax:702-664-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty