Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | E138738 | CA |
NPI | 1144846072 |
---|---|
Provider Name | Nicholas Christian Brown |
First Address | Santa Cruz, CA 95062-4669 |
Second Address | Santa Cruz, CA 95062-4669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2020 |
Last Update Date | 16/06/2020 |