Healthcare Provider Details

I. General information

NPI: 1356847826
Provider Name (Legal Business Name): ASHTEN BROOK WAKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

520 ULTIMO AVE
LONG BEACH CA
90814-2045
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8888
  • Fax:
Mailing address:
  • Phone: 949-702-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA160153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: