Provider Demographics
NPI:1770785610
Name:CHANDRASOMA, BROOKE BAFUS (MD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:BAFUS
Last Name:CHANDRASOMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 50148
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91115-0148
Mailing Address - Country:US
Mailing Address - Phone:626-486-0181
Mailing Address - Fax:626-486-0189
Practice Address - Street 1:10 CONGRESS ST STE 155
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-486-0181
Practice Address - Fax:626-486-0189
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2020-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA97268207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine