Healthcare Provider Details

I. General information

NPI: 1407883358
Provider Name (Legal Business Name): CARMEN BROWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/04/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 CALLE RAFAEL LASA
AGUAS BUENAS PR
00703-3212
US

IV. Provider business mailing address

PO BOX 1277
GURABO PR
00778-1277
US

V. Phone/Fax

Practice location:
  • Phone: 787-737-2311
  • Fax: 787-737-2311
Mailing address:
  • Phone: 787-737-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23658
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: