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General NPI Number Information
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NPI Number | 1962945063
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Entity Type | Individual
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Provider Name | DERRIC DEVON BROWN SR.
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Gender | Male
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 55 SHAW AVE STE 120
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City | CLOVIS
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State | CA
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Zip | 93612-3819
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Country | US
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Telephone | 310-421-5622
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Fax |
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Provider Business Mailing Address
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Address Line | 5307 N EL SOL AVE
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City | FRESNO
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State | CA
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Zip | 93722-6120
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Country | US
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Telephone | 310-421-5622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 65639
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License Number State | CA
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