Healthcare Provider Details

I. General information

NPI: 1508065111
Provider Name (Legal Business Name): ERICA RUTMAN BROWN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 DEEP VALLEY DR SUITE 287
ROLLING HILLS ESTATES CA
90274-3664
US

IV. Provider business mailing address

550 DEEP VALLEY DR SUITE 287
ROLLING HILLS ESTATES CA
90274-3664
US

V. Phone/Fax

Practice location:
  • Phone: 310-541-7800
  • Fax: 310-541-7808
Mailing address:
  • Phone: 310-541-7800
  • Fax: 310-541-7808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: