Healthcare Provider Details

I. General information

NPI: 1821040130
Provider Name (Legal Business Name): LOLA BURNETT BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 W MAIN ST
EL CENTRO CA
92243-3040
US

IV. Provider business mailing address

385 W. MAIN STREET
EL CENTRO CA
92243
US

V. Phone/Fax

Practice location:
  • Phone: 760-339-7202
  • Fax: 760-339-4514
Mailing address:
  • Phone: 760-339-7202
  • Fax: 760-339-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberFB6201406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: