Individual
MARK BROOKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1711 W TEMPLE ST, LOS ANGELES, CA 90026-7329
(213) 989-6160
Mailing address
1711 W TEMPLE ST, LOS ANGELES, CA 90026-7329
(213) 989-6160
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
769425
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NON-MEDICARE
CA
Enumeration date
02/06/2023
Last updated
02/17/2023
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