Provider Demographics
NPI:1447766415
Name:BROWN, RONNELL
Entity type:Individual
Prefix:
First Name:RONNELL
Middle Name:
Last Name:BROWN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 E PALMDALE BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4750
Mailing Address - Country:US
Mailing Address - Phone:661-208-4699
Mailing Address - Fax:661-208-4761
Practice Address - Street 1:1050 E PALMDALE BLVD STE 211
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4750
Practice Address - Country:US
Practice Address - Phone:661-208-4699
Practice Address - Fax:661-208-4761
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator