Healthcare Provider Details

I. General information

NPI: 1073382081
Provider Name (Legal Business Name): ALEXIS K BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 CARROLL CANYON RD STE 140
SAN DIEGO CA
92121-3758
US

IV. Provider business mailing address

244 MADISON AVE STE 141
NEW YORK NY
10016-2817
US

V. Phone/Fax

Practice location:
  • Phone: 858-295-0501
  • Fax: 308-646-6140
Mailing address:
  • Phone: 669-201-0667
  • Fax: 818-616-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: