Provider Demographics
NPI:1508960667
Name:BROOKS, NORMAN ASHER (MD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:ASHER
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 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 690
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-907-8144
Mailing Address - Fax:818-907-5967
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 690
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-907-8144
Practice Address - Fax:818-907-5967
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25704207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G257040Medicaid
G25704Medicare ID - Type Unspecified
CA00G257040Medicaid