Provider Demographics
NPI:1033202650
Name:BROWN, LEZLEY (MD)
Entity Type:Individual
Prefix:
First Name:LEZLEY
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 DESTINY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2995
Mailing Address - Country:US
Mailing Address - Phone:916-624-1777
Mailing Address - Fax:916-624-1770
Practice Address - Street 1:6960 DESTINY DR STE 100
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677
Practice Address - Country:US
Practice Address - Phone:916-624-1777
Practice Address - Fax:916-624-1770
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52481207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC52481OtherMEDICAL LICENSE NUMBER