Provider Demographics
NPI:1477098408
Name:DANDRIDGE BROWN, TENISHA (LAC)
Entity Type:Individual
Prefix:
First Name:TENISHA
Middle Name:
Last Name:DANDRIDGE BROWN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 33RD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-3233
Mailing Address - Country:US
Mailing Address - Phone:410-262-4308
Mailing Address - Fax:
Practice Address - Street 1:3101 33RD ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-3233
Practice Address - Country:US
Practice Address - Phone:916-741-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16090171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist