Provider Demographics
NPI:1245226505
Name:H LEON BROOKS, M.D. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:H LEON BROOKS, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-855-0752
Mailing Address - Street 1:8670 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2924
Mailing Address - Country:US
Mailing Address - Phone:310-855-0752
Mailing Address - Fax:310-855-0753
Practice Address - Street 1:8670 WILSHIRE BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2924
Practice Address - Country:US
Practice Address - Phone:310-855-0752
Practice Address - Fax:310-855-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24190Medicare UPIN