Healthcare Provider Details

I. General information

NPI: 1760318224
Provider Name (Legal Business Name): CARLOTTA D BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 PARKWAY DR
LA MESA CA
91942-1535
US

IV. Provider business mailing address

7050 PARKWAY DR
LA MESA CA
91942-1535
US

V. Phone/Fax

Practice location:
  • Phone: 619-667-6065
  • Fax:
Mailing address:
  • Phone: 619-954-8160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: