Healthcare Provider Details

I. General information

NPI: 1750078465
Provider Name (Legal Business Name): OLIVIA AYANNA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date: 08/05/2025
Reactivation Date: 10/24/2025

III. Provider practice location address

2420 MARTIN RD STE 200
FAIRFIELD CA
94534-8610
US

IV. Provider business mailing address

542 E L ST
BENICIA CA
94510-3447
US

V. Phone/Fax

Practice location:
  • Phone: 707-399-4520
  • Fax:
Mailing address:
  • Phone: 925-586-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: