Provider Demographics
NPI:1013013150
Name:BROOKS, OLIVER TATE (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:TATE
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 COMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-3628
Mailing Address - Country:US
Mailing Address - Phone:323-564-4331
Mailing Address - Fax:323-563-1636
Practice Address - Street 1:10300 COMPTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-3628
Practice Address - Country:US
Practice Address - Phone:323-564-4331
Practice Address - Fax:323-563-1636
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49006208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG00613OtherMEDI-CAL NO.
CAWG00613OtherMEDI-CAL NO.