Provider Demographics
NPI:1063675031
Name:BROWN, ROBERT C (LVN, LPN)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:LVN, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9551 OLYMPIC DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-4842
Mailing Address - Country:US
Mailing Address - Phone:714-968-2095
Mailing Address - Fax:
Practice Address - Street 1:3115 RED HILL AVE
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4517
Practice Address - Country:US
Practice Address - Phone:714-850-8405
Practice Address - Fax:714-850-8455
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN156970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health