Provider Demographics
NPI:1255046751
Name:PARVIN, BROOKS WALTON (PA-C)
Entity type:Individual
Prefix:
First Name:BROOKS
Middle Name:WALTON
Last Name:PARVIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EL CAMINO REAL FL 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3299
Mailing Address - Country:US
Mailing Address - Phone:650-504-3350
Mailing Address - Fax:
Practice Address - Street 1:1200 EL CAMINO REAL FL 3
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3299
Practice Address - Country:US
Practice Address - Phone:650-742-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant