Healthcare Provider Details

I. General information

NPI: 1376157362
Provider Name (Legal Business Name): HAROLD C BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/07/2020
Certification Date: 09/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 HOPKINS ST APT 4
BERKELEY CA
94707-2737
US

IV. Provider business mailing address

1515 HOPKINS ST APT 4
BERKELEY CA
94707-2737
US

V. Phone/Fax

Practice location:
  • Phone: 510-393-6890
  • Fax:
Mailing address:
  • Phone: 510-393-6890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number54375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: