Provider Demographics
NPI:1689121972
Name:BROWN, EBONY P
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:P
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 OLD COBBLE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4051
Mailing Address - Country:US
Mailing Address - Phone:917-564-2414
Mailing Address - Fax:
Practice Address - Street 1:3725 OLD COBBLE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-4051
Practice Address - Country:US
Practice Address - Phone:917-564-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management