Healthcare Provider Details

I. General information

NPI: 1235043555
Provider Name (Legal Business Name): TINA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 S WESTERN AVE
LOS ANGELES CA
90047-1124
US

IV. Provider business mailing address

PO BOX 2332
INGLEWOOD CA
90305-0332
US

V. Phone/Fax

Practice location:
  • Phone: 323-712-0344
  • Fax:
Mailing address:
  • Phone: 323-712-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: