Provider Demographics
NPI:1174503403
Name:BROOKS, DAVID MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6404 WILSHIRE BLVD
Mailing Address - Street 2:STE 1030
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5501
Mailing Address - Country:US
Mailing Address - Phone:310-498-0555
Mailing Address - Fax:310-684-2778
Practice Address - Street 1:6404 WILSHIRE BLVD
Practice Address - Street 2:STE 1030
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5501
Practice Address - Country:US
Practice Address - Phone:310-498-0555
Practice Address - Fax:310-684-2778
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7003103TC0700X
CAPSY 20877103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174503403OtherCIGNA HEALTHCARE/CBH
CAOPL208770OtherBLUE SHIELD OF CALIFORNIA
CAW20435OtherMEDICARE GROUP ID
CA1174503403OtherUNITED HEALTHCARE
1143651OtherCAQH IDENTIFIER
CAW20435OtherMEDICARE GROUP ID