Provider Demographics
NPI:1295863009
Name:BROOKS, H LEON (MD)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:LEON
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARRY
Other - Middle Name:LEON
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA24906AMedicare PIN
CAA24190Medicare UPIN