Provider Demographics
NPI:1952315640
Name:BROOKS, MAI (MD)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2190 LYNN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1980
Mailing Address - Country:US
Mailing Address - Phone:805-379-4677
Mailing Address - Fax:805-495-1829
Practice Address - Street 1:2190 LYNN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1980
Practice Address - Country:US
Practice Address - Phone:805-379-4677
Practice Address - Fax:805-495-1829
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG814432086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G814430Medicaid
CAG03087Medicare UPIN
CA00G814430Medicaid
CAWG81443BMedicare PIN