Provider Demographics
NPI:1023295227
Name:BROWN, BLANCA (PHD)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 N. GRISMER AVE #73
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-4203
Mailing Address - Country:US
Mailing Address - Phone:818-563-3501
Mailing Address - Fax:
Practice Address - Street 1:1711 GRISMER AVE APT 73
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3704
Practice Address - Country:US
Practice Address - Phone:818-563-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner