Provider Demographics
NPI:1629405725
Name:BROWN, GINILLE JASMIN LAZARO (NP)
Entity Type:Individual
Prefix:
First Name:GINILLE
Middle Name:JASMIN LAZARO
Last Name:BROWN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 CAMINO DE LA COSTA APT A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5408
Mailing Address - Country:US
Mailing Address - Phone:916-690-1368
Mailing Address - Fax:
Practice Address - Street 1:6501 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-1805
Practice Address - Country:US
Practice Address - Phone:562-928-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA847132163W00000X
CA23783363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse