=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487117933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIKKIA MONIQUE BROWN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2019
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5101 MARKET ST STE 2100
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92114-2224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-565-0064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29483 RANCHO CALIFORNIA RD APT 618
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92591-5249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-565-0064
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 147289
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------