MEDICARE: DR. GAYLIA D. BROWN PH.D.

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	103TC0700X	Clinical Psychologist	PSY 5233	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770667024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYLIA D. BROWN PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 12621
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92039-2621
Country	:	US
Telephone Number	:	619-260-0774
Fax Number	:

Provider Business Practice Location Address
First Line	:	591 CAMINO DE LA REINA
Second Line	:	SUITE 318
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3102
Country	:	US
Telephone Number	:	619-260-0774
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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