Provider Demographics
NPI:1740551845
Name:BROWN, ROSLYN ELAINE
Entity type:Individual
Prefix:MS
First Name:ROSLYN
Middle Name:ELAINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ROS
Other - Middle Name:ELAINE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3121 YUMA DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95111-1202
Mailing Address - Country:US
Mailing Address - Phone:408-518-9913
Mailing Address - Fax:
Practice Address - Street 1:3121 YUMA DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95111-1202
Practice Address - Country:US
Practice Address - Phone:408-518-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN3434045172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver