Provider Demographics
NPI:1306287404
Name:BROOME, NATASHA DENENA
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:DENENA
Last Name:BROOME
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NATASHA
Other - Middle Name:DENENA
Other - Last Name:BROOME-SHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19440 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-3933
Mailing Address - Country:US
Mailing Address - Phone:951-347-9294
Mailing Address - Fax:909-258-3817
Practice Address - Street 1:19440 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-3933
Practice Address - Country:US
Practice Address - Phone:951-347-9294
Practice Address - Fax:909-258-3817
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner