Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 50042 | CA |
NPI | 1073687034 |
---|---|
Provider Name | Dr. Carolyn Lissau Brown |
First Address | San Francisco, CA 94127-1527 |
Second Address | San Francisco, CA 94110-1210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 08/07/2007 |