Healthcare Provider Details

I. General information

NPI: 1295765147
Provider Name (Legal Business Name): DIANE KATHLEEN BROWN RDHAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 ADAMS AVE UNIT 6
SAN DIEGO CA
92116-1504
US

IV. Provider business mailing address

3033 ADAMS AVE UNIT #6
SAN DIEGO CA
92116-1504
US

V. Phone/Fax

Practice location:
  • Phone: 619-823-4616
  • Fax: 619-584-4257
Mailing address:
  • Phone: 619-823-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDHAP96
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: