Healthcare Provider Details

I. General information

NPI: 1558115691
Provider Name (Legal Business Name): TREVOR BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4282 GENESEE AVE STE 302
SAN DIEGO CA
92117-4985
US

IV. Provider business mailing address

2130 GLYNNWOOD DR
SAVANNAH GA
31404-5911
US

V. Phone/Fax

Practice location:
  • Phone: 858-284-0070
  • Fax: 858-284-0071
Mailing address:
  • Phone: 858-692-8921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: