Provider Demographics
NPI:1376039438
Name:BROWN, AZIA
Entity Type:Individual
Prefix:
First Name:AZIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 TALBOT AVE APT M15
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-2667
Mailing Address - Country:US
Mailing Address - Phone:510-828-3405
Mailing Address - Fax:
Practice Address - Street 1:365 TALBOT AVE APT M15
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2667
Practice Address - Country:US
Practice Address - Phone:510-828-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service