Healthcare Provider Details

I. General information

NPI: 1750778148
Provider Name (Legal Business Name): WANIKA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 BUSINESS CENTER DR STE 210
FAIRFIELD CA
94534-1696
US

IV. Provider business mailing address

4820 BUSINESS CENTER DR STE 210
FAIRFIELD CA
94534-1696
US

V. Phone/Fax

Practice location:
  • Phone: 707-224-8266
  • Fax: 707-427-1637
Mailing address:
  • Phone: 707-427-1845
  • Fax: 707-427-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSSVCQEYP
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberMPSSVCQEYP
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: