Individual
BROOKE LARIOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2080 S E ST, SAN BERNARDINO, CA 92408-2706
(909) 388-9191
Mailing address
12168 MOUNT VERNON AVE UNIT 90, GRAND TERRACE, CA 92313-5546
(951) 640-6373
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95017028
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124100383
—
CA
Enumeration date
06/30/2009
Last updated
05/23/2022
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