Healthcare Provider Details

I. General information

NPI: 1568491314
Provider Name (Legal Business Name): ARMENTA TIGGS-BROWN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43830 10TH ST W
LANCASTER CA
93534-4826
US

IV. Provider business mailing address

39925 MEADOWCREST WAY
PALMDALE CA
93551-5251
US

V. Phone/Fax

Practice location:
  • Phone: 661-940-1421
  • Fax:
Mailing address:
  • Phone: 661-714-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: