Healthcare Provider Details

I. General information

NPI: 1659259158
Provider Name (Legal Business Name): BRANDEN BROWN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 E IMPERIAL HWY
LYNWOOD CA
90262-2609
US

IV. Provider business mailing address

3630 E IMPERIAL HWY
LYNWOOD CA
90262-2609
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-8210
  • Fax:
Mailing address:
  • Phone: 310-900-8210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95221657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: