Provider Demographics
NPI:1073720553
Name:BROWN, DANETTE MONIQUE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:MONIQUE
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-4953
Mailing Address - Country:US
Mailing Address - Phone:805-455-9273
Mailing Address - Fax:
Practice Address - Street 1:251 W MEDICAL CENTER BLVD
Practice Address - Street 2:300
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4242
Practice Address - Country:US
Practice Address - Phone:281-557-0300
Practice Address - Fax:281-557-3301
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15163363A00000X
TXPA09646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant