Healthcare Provider Details

I. General information

NPI: 1649621202
Provider Name (Legal Business Name): NOEL M. BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOEL M. ROBERTS

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2523 W 7TH ST
LOS ANGELES CA
90057-3801
US

IV. Provider business mailing address

2523 W 7TH ST
LOS ANGELES CA
90057-3801
US

V. Phone/Fax

Practice location:
  • Phone: 213-480-1557
  • Fax:
Mailing address:
  • Phone: 213-480-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: