Healthcare Provider Details

I. General information

NPI: 1588574297
Provider Name (Legal Business Name): MRS. LISA RENE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13039 LAJARA STREET
CERRITOS CA
90703
US

IV. Provider business mailing address

13039 LAJARA STREET
CERRITOS CA
90703-6156
US

V. Phone/Fax

Practice location:
  • Phone: 562-754-3098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number583265
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: