Provider Demographics
NPI:1215747126
Name:CONTRERAS, BROOKLYNN NICHOLE
Entity type:Individual
Prefix:
First Name:BROOKLYNN
Middle Name:NICHOLE
Last Name:CONTRERAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 N 63RD PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4528
Mailing Address - Country:US
Mailing Address - Phone:951-426-8502
Mailing Address - Fax:
Practice Address - Street 1:1513 N 63RD PL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4528
Practice Address - Country:US
Practice Address - Phone:951-426-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program