MEDICARE: THEODAWN BROWN PA-C

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	363AM0700X	Medical Physician Assistant	PA12076	CA

General Provider Information

NPI Number	:	1265467575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODAWN BROWN PA-C

Provider Business Mailing Address
First Line	:	3831 HUGHES AVE
Second Line	:	SUITE 705
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2751
Country	:	US
Telephone Number	:	213-253-2677
Fax Number	:	213-253-5082

Provider Business Practice Location Address
First Line	:	3831 HUGHES AVE
Second Line	:	SUITE 705
City	:	CULVER CITY
State	:	CA
Zip	:	90232-2751
Country	:	US
Telephone Number	:	213-253-2677
Fax Number	:	213-253-5082

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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Directions to “ THEODAWN BROWN PA-C” Practice Location

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