Provider Demographics
NPI:1487772182
Name:BROOKS, CHANDRA EVETTEMARIE
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:EVETTEMARIE
Last Name:BROOKS
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 1:38550 22ND ST E UNIT 6
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4074
Mailing Address - Country:US
Mailing Address - Phone:559-347-1229
Mailing Address - Fax:
Practice Address - Street 1:40015 SIERRA HWY
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2101
Practice Address - Country:US
Practice Address - Phone:661-526-5061
Practice Address - Fax:661-526-4931
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator