Healthcare Provider Details

I. General information

NPI: 1417871401
Provider Name (Legal Business Name): RAVEN DESHAY BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1135 FORTUNA ST
PERRIS CA
92571-7709
US

IV. Provider business mailing address

25105 JOHN F KENNEDY DR APT D17
MORENO VALLEY CA
92551-7105
US

V. Phone/Fax

Practice location:
  • Phone: 760-590-9714
  • Fax:
Mailing address:
  • Phone: 760-590-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: