Provider Demographics
NPI:1346278587
Name:BROOKS, MARLON (MD)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
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 1:10515 BALBOA BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6343
Mailing Address - Country:US
Mailing Address - Phone:818-831-6611
Mailing Address - Fax:818-831-3836
Practice Address - Street 1:10515 BALBOA BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6343
Practice Address - Country:US
Practice Address - Phone:818-831-6611
Practice Address - Fax:818-831-3836
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71729207VX0000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G717291Medicaid
CAG71729Medicare PIN
CA00G717291Medicaid