Healthcare Provider Details

I. General information

NPI: 1508906421
Provider Name (Legal Business Name): BROOKE ALLISON GOLDNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ALLISON GOLDNER TADLOCK M.D.

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 E 7TH ST
LONG BEACH CA
90804-4590
US

IV. Provider business mailing address

16822 BAYVIEW DR
HUNTINGTON BEACH CA
92649-2805
US

V. Phone/Fax

Practice location:
  • Phone: 562-284-0108
  • Fax:
Mailing address:
  • Phone: 562-715-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA94022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: