Healthcare Provider Details

I. General information

NPI: 1336208206
Provider Name (Legal Business Name): MR. MICHAEL PAUL BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WEST VISTA WAY BPSR VISTA #407
VISTA CA
92083
US

IV. Provider business mailing address

550 WEST VISTA WAY BPSR VISTA #407
VISTA CA
92083
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1092
  • Fax: 760-758-8481
Mailing address:
  • Phone: 760-758-1092
  • Fax: 760-758-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: