Provider Demographics
NPI:1083693006
Name:BROWN GONZALEZ, BLAIRE L (MS)
Entity Type:Individual
Prefix:
First Name:BLAIRE
Middle Name:L
Last Name:BROWN GONZALEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 ROSCOE BLVD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3904
Mailing Address - Country:US
Mailing Address - Phone:818-375-3194
Mailing Address - Fax:
Practice Address - Street 1:13352 CANTARA ST
Practice Address - Street 2:S1- 104
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5508
Practice Address - Country:US
Practice Address - Phone:818-375-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS