Provider Demographics
NPI:1376546846
Name:BROWN, ELISA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISA
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 1:194 COHASSET RD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-2202
Mailing Address - Country:US
Mailing Address - Phone:530-893-2303
Mailing Address - Fax:530-893-3607
Practice Address - Street 1:194 COHASSET RD
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2202
Practice Address - Country:US
Practice Address - Phone:530-893-2303
Practice Address - Fax:530-893-3607
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70140208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G701400Medicaid
CAF61085Medicare UPIN
CA00G701400Medicare ID - Type Unspecified