MEDICARE: REVA P BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1154038859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REVA P BROWN

Provider Business Mailing Address
First Line	:	8655 RINCON AVE
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-2327
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8655 RINCON AVE
Second Line	:
City	:	SUN VALLEY
State	:	CA
Zip	:	91352-2327
Country	:	US
Telephone Number	:	818-284-5436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2022
Last Update Date	:	11/02/2022

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Directions to “ REVA P BROWN ” Practice Location

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