Provider Demographics
NPI:1508906421
Name:GOLDNER, BROOKE ALLISON (MD)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ALLISON
Last Name:GOLDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:ALLISON
Other - Last Name:GOLDNER TADLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:16822 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2805
Mailing Address - Country:US
Mailing Address - Phone:562-715-7123
Mailing Address - Fax:
Practice Address - Street 1:2025 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-4590
Practice Address - Country:US
Practice Address - Phone:562-284-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA940222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry