1235197633 NPI number — DR. SANDRA JEAN BROWN PH.D.

Table of content: DR. SANDRA JEAN BROWN PH.D. (NPI 1235197633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235197633 NPI number — DR. SANDRA JEAN BROWN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
SANDRA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CSANYI
Provider Other First Name:
SANDRA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
N/A
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235197633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 232410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92193-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-543-6164
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UCSD MEDICAL CENTER
Provider Second Line Business Practice Location Address:
200 WEST ARBOR DRIVE MC 8201
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-8201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-497-6659
Provider Business Practice Location Address Fax Number:
619-543-3183
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  PSY14942 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PSY149420 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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