Provider Demographics
NPI:1376546044
Name:BROWN, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 RESERVATION RD
Mailing Address - Street 2:D
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-3059
Mailing Address - Country:US
Mailing Address - Phone:831-971-8734
Mailing Address - Fax:
Practice Address - Street 1:215 RESERVATION RD
Practice Address - Street 2:D
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3059
Practice Address - Country:US
Practice Address - Phone:831-971-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A604580Medicare ID - Type Unspecified
CAG75931Medicare UPIN