MEDICARE: WANIKA 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	175T00000X	Peer Specialist	MPSSVCQEYP	CA
2	225400000X	Rehabilitation Practitioner
3	172V00000X	Community Health Worker	MPSSVCQEYP	CA

General Provider Information

NPI Number	:	1750778148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANIKA BROWN

Provider Business Mailing Address
First Line	:	4820 BUSINESS CENTER DR STE 210
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-1696
Country	:	US
Telephone Number	:	707-427-1845
Fax Number	:	707-427-1637

Provider Business Practice Location Address
First Line	:	4820 BUSINESS CENTER DR STE 210
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-1696
Country	:	US
Telephone Number	:	707-224-8266
Fax Number	:	707-427-1637

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

Provider Enumeration Date	:	04/23/2015
Last Update Date	:	12/10/2025

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Directions to “ WANIKA BROWN ” Practice Location

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