Healthcare Provider Details

I. General information

NPI: 1194985242
Provider Name (Legal Business Name): DANIEL JONATHAN BROWN M.D., F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE STE 640
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

PO BOX 407
RANCHO SANTA FE CA
92067-0407
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-1500
  • Fax: 619-374-1498
Mailing address:
  • Phone: 619-461-1500
  • Fax: 619-374-1498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA103653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: