Healthcare Provider Details

I. General information

NPI: 1205767548
Provider Name (Legal Business Name): JONATHAN BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 FRUITRIDGE RD # 1045
SACRAMENTO CA
95822-3148
US

IV. Provider business mailing address

334 GRAND BLVD APT 1
SAN MATEO CA
94401-2340
US

V. Phone/Fax

Practice location:
  • Phone: 404-465-1665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-494876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: