Provider Demographics
NPI:1659136059
Name:BROWN, CHRISTOPHER KAVON
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:KAVON
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 1:2001 N RANCHO AVE APT 35D
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1248
Mailing Address - Country:US
Mailing Address - Phone:323-845-5373
Mailing Address - Fax:
Practice Address - Street 1:2001 N RANCHO AVE APT 35D
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1248
Practice Address - Country:US
Practice Address - Phone:323-845-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker