Provider Demographics
NPI:1417961442
Name:BROOKS, GEMMA A (NP)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3000 Q ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-5336
Practice Address - Fax:916-733-5385
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN209684207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7372691OtherAETNA
CA000810374572OtherPHCS
CARN209684Medicaid
CA2688716OtherUNITED
CA90199813OtherPACIFICARE
CAN209684OtherBLUE CROSS
CA0032273OtherCIGNA
CA1750226OtherGREAT WEST
CA461125OtherINTERPLAN
CA000810374572OtherPHCS
CA1750226OtherGREAT WEST