Provider Demographics
NPI:1629199286
Name:BROOKS, MADELENE (PA)
Entity Type:Individual
Prefix:MRS
First Name:MADELENE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14114 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-9113
Mailing Address - Country:US
Mailing Address - Phone:951-656-3303
Mailing Address - Fax:951-656-3375
Practice Address - Street 1:14114 BUSINESS CENTER DR
Practice Address - Street 2:SUITE E
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-9113
Practice Address - Country:US
Practice Address - Phone:951-656-3303
Practice Address - Fax:951-656-3375
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant