Most Relevant Information
Provider Data
| NPI Number: | 1003664350 |
| Provider Name: | BROOKE BAXSTRESSER |
| Entity Type: | Individual |
| Taxonomy Code: | 167G00000X |
| Specialty: | Licensed Psychiatric Technician |
| License Number: | 41163 |
Most Important Dates
| Enumeration Date: | 05/10/2024 |
| Last Updated: | 08/20/2024 |
Provider Practice Location
2975 MCMILLAN AVE STE 162
SAN LUIS OBISPO
CA
934016768
Practice Location Phone/Fax
| Phone: | 8054394890 |
| Fax: |
Provider Mailing Location
2975 MCMILLAN AVE STE 164
SAN LUIS OBISPO
CA
934016768
Provider Mailing Phone/Fax
| Phone: | 8054394890 |
| Fax: |