Provider Demographics
NPI:1063447662
Name:DAVID M BROOKS PHD PA
Entity Type:Organization
Organization Name:DAVID M BROOKS PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHEAL
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-498-0555
Mailing Address - Street 1:8060 MELROSE AVE
Mailing Address - Street 2:STE 215
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-7017
Mailing Address - Country:US
Mailing Address - Phone:310-498-0555
Mailing Address - Fax:323-951-0940
Practice Address - Street 1:8060 MELROSE AVE
Practice Address - Street 2:STE 215
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-7017
Practice Address - Country:US
Practice Address - Phone:310-498-0555
Practice Address - Fax:323-951-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7003103TC0700X
CAPSY 20877103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7403Medicare ID - Type UnspecifiedGROUP PROVIDER ID
CAW20435Medicare ID - Type UnspecifiedGROUP PROVIDER ID