Healthcare Provider Details

I. General information

NPI: 1487045324
Provider Name (Legal Business Name): ANGELA ROSE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W OCEAN AVE
LOMPOC CA
93436-6630
US

IV. Provider business mailing address

113 NORTH H ST SUITE F
LOMPOC CA
93436
US

V. Phone/Fax

Practice location:
  • Phone: 805-736-0357
  • Fax:
Mailing address:
  • Phone: 805-322-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9082
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: