Provider Demographics
NPI:1770953119
Name:BROWN, GILA
Entity type:Individual
Prefix:
First Name:GILA
Middle Name:
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 1:6310 SAN VICENTE BLVD STE 425
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5446
Mailing Address - Country:US
Mailing Address - Phone:310-497-7461
Mailing Address - Fax:
Practice Address - Street 1:6310 SAN VICENTE BLVD STE 425
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5446
Practice Address - Country:US
Practice Address - Phone:310-497-7461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001854106H00000X
CA89063106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist