Healthcare Provider Details

I. General information

NPI: 1891522512
Provider Name (Legal Business Name): JESSICA N BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 HOWARD ST
SAN FRANCISCO CA
94103-2638
US

IV. Provider business mailing address

1380 HOWARD ST
SAN FRANCISCO CA
94103-2638
US

V. Phone/Fax

Practice location:
  • Phone: 510-693-1171
  • Fax:
Mailing address:
  • Phone: 510-693-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: