Healthcare Provider Details

I. General information

NPI: 1639914294
Provider Name (Legal Business Name): BIANCA CHANNEL BROWN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 N ORANGE GROVE AVE
POMONA CA
91767-3006
US

IV. Provider business mailing address

840 TOWNE CENTER DR
POMONA CA
91767-5900
US

V. Phone/Fax

Practice location:
  • Phone: 909-620-7200
  • Fax: 909-620-5800
Mailing address:
  • Phone: 909-398-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95030821
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95203758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: