Provider Demographics
NPI:1134803950
Name:BROWN, CARL HARLEN III (OTHER)
Entity type:Individual
Prefix:MR
First Name:CARL
Middle Name:HARLEN
Last Name:BROWN
Suffix:III
Gender:M
Credentials:OTHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 W CLINTON AVE
Mailing Address - Street 2:BUILDING A SUITE B
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-4206
Mailing Address - Country:US
Mailing Address - Phone:559-264-7521
Mailing Address - Fax:559-570-0388
Practice Address - Street 1:2550 W CLINTON AVE
Practice Address - Street 2:BUILDING A SUITE B
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-4206
Practice Address - Country:US
Practice Address - Phone:559-264-7521
Practice Address - Fax:559-570-0388
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker