Provider Demographics
NPI:1518097450
Name:BROWN, MINETTE PLAZA (NP)
Entity Type:Individual
Prefix:
First Name:MINETTE
Middle Name:PLAZA
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MINETTE
Other - Middle Name:PLAZA
Other - Last Name:PETAGARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22357 VICTORY BLVD APT 107
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2400
Mailing Address - Country:US
Mailing Address - Phone:818-606-7942
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DRIVE
Practice Address - Street 2:NORTH ANNEX
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-364-3107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14325363L00000X
CA505303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ56885Medicare UPIN