Provider Demographics
NPI:1952645939
Name:BROOKS, ALLEN
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 E AZURE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6886
Mailing Address - Country:US
Mailing Address - Phone:702-485-7075
Mailing Address - Fax:
Practice Address - Street 1:1516 E TROPICANA AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6525
Practice Address - Country:US
Practice Address - Phone:702-834-3563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker