Provider Demographics
NPI:1649003864
Name:BROWN, ANTONIA M
Entity type:Individual
Prefix:
First Name:ANTONIA
Middle Name:M
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 1:1001 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5749
Mailing Address - Country:US
Mailing Address - Phone:714-517-8950
Mailing Address - Fax:714-517-9244
Practice Address - Street 1:140 W GUINIDA LN
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6101
Practice Address - Country:US
Practice Address - Phone:714-517-8950
Practice Address - Fax:714-517-9244
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool