Healthcare Provider Details

I. General information

NPI: 1730483710
Provider Name (Legal Business Name): JUDITH RENEE BROWN RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2011
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 LA JOLLA AVE
CLOVIS CA
93619-8951
US

IV. Provider business mailing address

923 LA JOLLA AVE
CLOVIS CA
93619-8951
US

V. Phone/Fax

Practice location:
  • Phone: 559-331-4879
  • Fax: 559-765-4262
Mailing address:
  • Phone: 559-331-4879
  • Fax: 559-765-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDHAP 322
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDHAP322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: