Provider Demographics
NPI:1255921862
Name:BROWN, JOHNATHAN CHARLES
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:CHARLES
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 1:501 S SPRING ST APT 1017
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1236
Mailing Address - Country:US
Mailing Address - Phone:213-915-2836
Mailing Address - Fax:
Practice Address - Street 1:729 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-5720
Practice Address - Country:US
Practice Address - Phone:323-814-9100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator