Healthcare Provider Details

I. General information

NPI: 1245373265
Provider Name (Legal Business Name): LINDA JEAN BROWN RAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 NORTH I STREET
LOMPOC CA
93436
US

IV. Provider business mailing address

1332 WEST WILLOW AVENUE
LOMPOC CA
93436
US

V. Phone/Fax

Practice location:
  • Phone: 805-740-9799
  • Fax: 805-740-2799
Mailing address:
  • Phone: 805-736-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberB0506090750
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: