Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

BROOKLYN HELENE DOUGLAS
NPI 1689256380
Student in an Organized Health Care Education/Training Program in San Diego, CA

Q: What is Brooklyn Douglas's NPI number?

The NPI number for Brooklyn Douglas is 1689256380. It was assigned to this individual provider in the NPPES registry on April 22, 2021.

Q: What is Brooklyn Douglas's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Brooklyn Douglas was last updated on July 31, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 22, 2021PECOS Enrolled

1031 25TH ST, SAN DIEGO, CA 92102(619) 232-6454 Get Directions Write a Review

NPPES record last updated: July 31, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Brooklyn Helene Douglas NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BROOKLYN HELENE DOUGLAS (NPI 1689256380) is an individual student in an organized health care education/training program in San Diego, California and active in the NPI registry since April 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1689256380

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameBROOKLYN HELENE DOUGLAS

Location Address1031 25TH STSan Diego, CA 92102-2102

Mailing Address3455 Kearny Villa Rd Apt 432San Diego, CA 92123-1985 · (925) 960-3262

Phone(619) 232-6454

Sole ProprietorYes

Medical School CMSOtherGraduated 2022

Enumeration DateApril 22, 2021

Last NPPES UpdateJuly 31, 2026

NPPES CertifiedJuly 31, 2026

✔ NPI 1689256380 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1031 25TH ST, San Diego, CA 92102

Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Brooklyn Helene Douglas is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4284130949

PECOS Enrollment IDI20251001002553

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JACKY LAU MFT-INTERN

Marriage & Family Therapist