Provider Demographics
NPI:1992954499
Name:BROOKINS, SAMUEL HYATT III (LVN)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:HYATT
Last Name:BROOKINS
Suffix:III
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 EAST ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4417
Mailing Address - Country:US
Mailing Address - Phone:760-966-1587
Mailing Address - Fax:
Practice Address - Street 1:2727 EAST ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4417
Practice Address - Country:US
Practice Address - Phone:760-966-1587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN187832164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse