Healthcare Provider Details

I. General information

NPI: 1689680522
Provider Name (Legal Business Name): IVAN ISRAEL BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BRIGHTON WAY STE 205
BEVERLY HILLS CA
90210-4709
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD PMB 749
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 310-853-5850
  • Fax:
Mailing address:
  • Phone: 310-853-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberA65321
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA65321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: