Provider Demographics
NPI:1467637454
Name:BROWN, JOHNNY C
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:C
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2811
Mailing Address - Country:US
Mailing Address - Phone:510-652-3300
Mailing Address - Fax:510-652-7720
Practice Address - Street 1:5709 MARKET ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2811
Practice Address - Country:US
Practice Address - Phone:510-652-3300
Practice Address - Fax:510-652-7720
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker