Healthcare Provider Details

I. General information

NPI: 1629369889
Provider Name (Legal Business Name): ALLAN WILTON BROWN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEVE WILTON BROWN

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 06/07/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W. COLTON AVENUE 522
REDLANDS CA
92374
US

IV. Provider business mailing address

25765 AMAPOLAS STREET
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 626-587-9600
  • Fax: 909-425-6635
Mailing address:
  • Phone: 909-425-7679
  • Fax: 909-425-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 24008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: