Provider Demographics
NPI:1285922526
Name:BROOKE, ANDREA S (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:S
Last Name:BROOKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:SCHWARTZBERG-BROOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:29625 STRAWBERRY HILL DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4012
Mailing Address - Country:US
Mailing Address - Phone:818-706-1064
Mailing Address - Fax:818-706-1064
Practice Address - Street 1:29625 STRAWBERRY HILL DR
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4012
Practice Address - Country:US
Practice Address - Phone:818-706-1064
Practice Address - Fax:818-706-1064
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 65428174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001605320Medicare PIN