Healthcare Provider Details

I. General information

NPI: 1013013150
Provider Name (Legal Business Name): OLIVER TATE BROOKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 COMPTON AVE
LOS ANGELES CA
90002-3628
US

IV. Provider business mailing address

10300 COMPTON AVE
LOS ANGELES CA
90002-3628
US

V. Phone/Fax

Practice location:
  • Phone: 323-564-4331
  • Fax: 323-563-1636
Mailing address:
  • Phone: 323-564-4331
  • Fax: 323-563-1636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG49006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: