Provider Demographics
NPI:1639487713
Name:NORMAN A. BROOKS, M.D., INC.
Entity Type:Organization
Organization Name:NORMAN A. BROOKS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF MEDICAL CORP.
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-907-8144
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:91436-2124
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:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-907-8144
Practice Address - Fax:818-907-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25704207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G257040Medicaid
CA00G257040Medicaid
CAG25704Medicare PIN