Provider Demographics
NPI:1225181498
Name:BROOKS, HERMAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:DAVID
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 1:2640 INDUSTRY WAY STE B
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4000
Mailing Address - Country:US
Mailing Address - Phone:310-639-5983
Mailing Address - Fax:310-639-5870
Practice Address - Street 1:2640 INDUSTRY WAY STE B
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4000
Practice Address - Country:US
Practice Address - Phone:310-639-5983
Practice Address - Fax:310-639-5870
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA341442084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A341440Medicaid
CA00A341440Medicaid