MEDICARE: DR. ROBERT ELLIOTT BROOKS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G15997	CA

General Provider Information

NPI Number	:	1396979134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ELLIOTT BROOKS M.D.

Provider Business Mailing Address
First Line	:	3243 STONER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-1123
Country	:	US
Telephone Number	:	310-390-3917
Fax Number	:	310-390-3917

Provider Business Practice Location Address
First Line	:	3243 STONER AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-1123
Country	:	US
Telephone Number	:	310-390-3917
Fax Number	:	310-390-3917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	05/07/2009

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