=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346275575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT BROWN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 EMELINE AVE 1ST FLOOR
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-454-4900
-----------------------------------------------------
Fax | 831-454-4663
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 EMELINE AVE
-----------------------------------------------------
City | SANTA CRUZ
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95060-1976
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-454-4900
-----------------------------------------------------
Fax | 831-454-4663
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | C50186
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | C50186
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------