Individual
BROOKE L BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8415 N PIMA RD STE 280, SCOTTSDALE, AZ 85258-4488
(480) 245-4425
(480) 245-4426
Mailing address
1663 W COMMERCE AVE, GILBERT, AZ 85233-4008
(602) 502-1068
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6536
AZ
363AS0400X
Surgical Physician Assistant
6536
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275506
—
AZ
Enumeration date
09/01/2016
Last updated
07/20/2020
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