Healthcare Provider Details

I. General information

NPI: 1265892350
Provider Name (Legal Business Name): BROOKS, TASHMAN, MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 03/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 SYCAMORE DR. #200
SIMI VALLEY CA
93065
US

IV. Provider business mailing address

2950 SYCAMORE DR. #200
SIMI VALLEY CA
93065
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-9400
  • Fax: 805-582-1344
Mailing address:
  • Phone: 805-527-9400
  • Fax: 805-582-1344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STEWART IRWIN BROOKS
Title or Position: CHIEF FINANCIAL OFFICER
Credential: M.D.
Phone: 805-527-9400