Provider Demographics
NPI:1447707575
Name:BROOKS, PRISCILLA YUKI
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:YUKI
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 1:1422 HARRISON ST.
Mailing Address - Street 2:BONITA HOUSE INC / BRIDGES TO RECOVERY
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3903
Mailing Address - Country:US
Mailing Address - Phone:510-809-1780
Mailing Address - Fax:510-893-1642
Practice Address - Street 1:1422 HARRISON ST.
Practice Address - Street 2:BONITA HOUSE INC / BRIDGES TO RECOVERY
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3903
Practice Address - Country:US
Practice Address - Phone:510-809-1780
Practice Address - Fax:510-893-1642
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator