Healthcare Provider Details

I. General information

NPI: 1548398118
Provider Name (Legal Business Name): LISA MARIE BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 STOCKTON BLVD SUITE 2112
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2315 STOCKTON BLVD- DEPARTMENT OF SURGERY NAOB, SUITE 6122
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3861
  • Fax: 916-734-3066
Mailing address:
  • Phone: 916-734-3447
  • Fax: 916-734-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA98718
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA98718
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA98718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: