Healthcare Provider Details

I. General information

NPI: 1124296728
Provider Name (Legal Business Name): ERIC BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW ST SUITE 100
BARSTOW CA
92311-2814
US

IV. Provider business mailing address

PO BOX 7369
REDLANDS CA
92375-0369
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-0376
  • Fax: 760-266-0377
Mailing address:
  • Phone: 909-792-0747
  • Fax: 909-792-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: