Healthcare Provider Details

I. General information

NPI: 1124971775
Provider Name (Legal Business Name): IESHIA TIANA BROWN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR STE 108
SAN DIEGO CA
92121-3022
US

IV. Provider business mailing address

3412 TROPHY DR
LA MESA CA
91941-8037
US

V. Phone/Fax

Practice location:
  • Phone: 619-333-3515
  • Fax:
Mailing address:
  • Phone: 619-252-1986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: