Healthcare Provider Details

I. General information

NPI: 1609587369
Provider Name (Legal Business Name): DEJAN ARMANI BROWN CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 12/13/2022
Certification Date: 12/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8380 CENTER DR STE E
LA MESA CA
91942-2952
US

IV. Provider business mailing address

1658 W 105TH ST
LOS ANGELES CA
90047-4451
US

V. Phone/Fax

Practice location:
  • Phone: 619-466-6077
  • Fax:
Mailing address:
  • Phone: 619-760-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: