Provider Demographics
NPI:1295866192
Name:BROWN, MITZIE (BA)
Entity Type:Individual
Prefix:MS
First Name:MITZIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 MOUNT LASSEN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSAMOND
Mailing Address - State:CA
Mailing Address - Zip Code:93560-5906
Mailing Address - Country:US
Mailing Address - Phone:661-816-6047
Mailing Address - Fax:661-272-1005
Practice Address - Street 1:190 SIERRA CT
Practice Address - Street 2:SUITE B2
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-7607
Practice Address - Country:US
Practice Address - Phone:661-272-4883
Practice Address - Fax:661-272-1005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator