Provider Demographics
NPI:1407879059
Name:BROWN, CARL LEON JR (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:LEON
Last Name:BROWN
Suffix:JR
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:MR
Other - First Name:CARL
Other - Middle Name:LEON
Other - Last Name:BROWN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:1571 W SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3333
Mailing Address - Country:US
Mailing Address - Phone:213-482-4400
Mailing Address - Fax:213-482-5100
Practice Address - Street 1:801 E MOUNTAIN VIEW ST
Practice Address - Street 2:SUITE # C
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-3052
Practice Address - Country:US
Practice Address - Phone:760-256-6680
Practice Address - Fax:760-256-6684
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 13853OtherLICENSE