Healthcare Provider Details

I. General information

NPI: 1861502718
Provider Name (Legal Business Name): GREGORY G BROWN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VASDHS 3350 LA JOLLA VILLAGE DR MC 116B
SAN DIEGO CA
92161-0001
US

IV. Provider business mailing address

7164 ARROYO GRANDE RD
SAN DIEGO CA
92129-2257
US

V. Phone/Fax

Practice location:
  • Phone: 858-642-3166
  • Fax: 858-552-7414
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number15246
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number15246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: