Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | A97902 | CA |
NPI | 1114173937 |
---|---|
Provider Name | Dr. Brook L Brouha |
First Address | Henderson, NV 89074-7759 |
Second Address | La Jolla, CA 92037-5138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2008 |
Last Update Date | 06/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DL390Z | MEDICARE PTAN (01) | CA |