Healthcare Provider Details

I. General information

NPI: 1245226505
Provider Name (Legal Business Name): H LEON BROOKS, M.D. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 WILSHIRE BLVD SUITE 206
BEVERLY HILLS CA
90211-2924
US

IV. Provider business mailing address

8670 WILSHIRE BLVD SUITE 206
BEVERLY HILLS CA
90211-2924
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-0752
  • Fax: 310-855-0753
Mailing address:
  • Phone: 310-855-0752
  • Fax: 310-855-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GIOVANNI AYALA
Title or Position: OFFICE MANAGER
Credential:
Phone: 310-855-0752