Provider Demographics
NPI:1801906789
Name:DIANA-BROOKS, KIMBERLY ANNE (DO)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:DIANA-BROOKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 W BETHANY HOME RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-1967
Mailing Address - Country:US
Mailing Address - Phone:602-841-0707
Mailing Address - Fax:602-841-0708
Practice Address - Street 1:3650 W BETHANY HOME RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-1967
Practice Address - Country:US
Practice Address - Phone:602-841-0707
Practice Address - Fax:602-841-0708
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3355207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG70467Medicare UPIN