Healthcare Provider Details

I. General information

NPI: 1063675031
Provider Name (Legal Business Name): ROBERT C BROWN LVN, LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 RED HILL AVE
COSTA MESA CA
92626-4517
US

IV. Provider business mailing address

9551 OLYMPIC DR
HUNTINGTON BEACH CA
92646-4842
US

V. Phone/Fax

Practice location:
  • Phone: 714-850-8405
  • Fax: 714-850-8455
Mailing address:
  • Phone: 714-968-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberVN156970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: