Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | G71729 | CA |
N | 207VX0000X | Obstetrician | G71729 | CA |
NPI | 1346278587 |
---|---|
Provider Name | Marlon Brooks |
First Address | Granada Hills, CA 91344-6343 |
Second Address | Granada Hills, CA 91344-6343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 14/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G717291 | (05) | CA |
F08299 | (02) | CA |