Healthcare Provider Details

I. General information

NPI: 1477599132
Provider Name (Legal Business Name): CHRISTINA R BROWN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20712 FARNSWORTH LN
HUNTINGTON BEACH CA
92646-5523
US

IV. Provider business mailing address

20712 FARNSWORTH LN
HUNTINGTON BEACH CA
92646-5523
US

V. Phone/Fax

Practice location:
  • Phone: 714-323-0166
  • Fax:
Mailing address:
  • Phone: 714-323-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberPT23614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: