Provider Demographics
NPI:1649375445
Name:BROWN, CANDIDA M (MD)
Entity type:Individual
Prefix:
First Name:CANDIDA
Middle Name:M
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 EMBARCADERO RD
Mailing Address - Street 2:STE 100
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3341
Mailing Address - Country:US
Mailing Address - Phone:925-691-9688
Mailing Address - Fax:925-691-9820
Practice Address - Street 1:400 TAYLOR BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2147
Practice Address - Country:US
Practice Address - Phone:925-691-9688
Practice Address - Fax:925-691-9820
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA046000174400000X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10943621OtherCAQH
CA1649375445Medicaid
10943621OtherCAQH
CAF52216Medicare UPIN