Provider Demographics
NPI:1679107148
Name:BROOKMAN, LINDA B (RDHAP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:B
Last Name:BROOKMAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4302
Mailing Address - Country:US
Mailing Address - Phone:310-422-3434
Mailing Address - Fax:
Practice Address - Street 1:25 25TH AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-4302
Practice Address - Country:US
Practice Address - Phone:310-422-3434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDHAP651124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist