Brooke Nycole Atilano

Key facts

NPI

1649965799

Entity type

Individual (NPI type 1)

Primary specialty

Peer Specialist 175T00000X

License

MPSS-DXFPLC (CA)

Practice address

2731 Nugget Ave
Lake Isabella, CA 93240-9456

Phone

(760) 463-5027

Fax

(760) 379-5332

NPI assigned

Apr 5, 2023

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 8, 2024.

{
    "created_epoch": "1680652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1649965799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2731 NUGGET AVE",
            "city": "LAKE ISABELLA",
            "state": "CA",
            "postal_code": "932409456",
            "telephone_number": "760-463-5027",
            "fax_number": "760-379-5332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2731 NUGGET AVE",
            "city": "LAKE ISABELLA",
            "state": "CA",
            "postal_code": "932409456",
            "telephone_number": "760-463-5027",
            "fax_number": "760-379-5332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ATILANO",
        "first_name": "BROOKE",
        "middle_name": "NYCOLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-05",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "CA",
            "license": "D5170094",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "CA",
            "license": "MPSS-DXFPLC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Isabella, CA

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• Sandra Allen
• Brandy Nicole Arana
• Rodolfo Rafael Arango Jr.
• Patricia Maria Arellano
• Skye Renee' Ayala Lopez
• Matthew Bader, LMFT
• Rosy Bergman
• Maria Teresa Biasiotto, MFT, RN
• Linda Dianne Block, MFT

All providers in Lake Isabella, CA · Peer Specialist in California