Provider Demographics
NPI:1962670141
Name:LASSITER-BROWN, BEVERLY JEAN (PA, MPH)
Entity Type:Individual
Prefix:PROF
First Name:BEVERLY
Middle Name:JEAN
Last Name:LASSITER-BROWN
Suffix:
Gender:F
Credentials:PA, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-1418
Mailing Address - Country:US
Mailing Address - Phone:310-748-7295
Mailing Address - Fax:
Practice Address - Street 1:25124 SPRINGFIELD CT
Practice Address - Street 2:SUITE 200
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1085
Practice Address - Country:US
Practice Address - Phone:661-678-2629
Practice Address - Fax:661-678-2729
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 11128363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical