Basic Information
| Provider Information | |||||||||
| NPI: | 1548278294 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROOKS-CANDELA | ||||||||
| FirstName: | MARSHA | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BROOKS | ||||||||
| OtherFirstName: | MARSHA | ||||||||
| OtherMiddleName: | ELLEN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 188 | ||||||||
| Address2: | |||||||||
| City: | MARANA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856530188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206824111 | ||||||||
| FaxNumber: | 5208183630 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 W HOSPITAL DR | ||||||||
| Address2: | STE 115 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857047892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207970011 | ||||||||
| FaxNumber: | 5207977550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/22/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35633 | AZ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 248941 | 01 | AZ | CIGNA | OTHER | 4124146 | 01 | AZ | AETNA | OTHER | 135915 | 01 | AZ | HEALTH CHOICE AZ | OTHER | 135915 | 05 | AZ | MEDICAID | 135915001 | 01 | AZ | ARIZONA PHYSICANS IPA | OTHER | AZ0919450 | 01 | AZ | BCBS | OTHER | 2Z4608 | 01 | AZ | HEALTH NET OF AZ | OTHER |