Active NPI
Diane Brown, P.A.
- Physician Assistant
- Lake Elsinore, CA
National Provider Identifier
1821147208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA14724
- Practice address
- 506 West Grahan Avenue Suite 107
Lake Elsinore, CA 92530 - Phone
- (951) 471-5116
- Fax
- (951) 471-5226
- NPI assigned
- Jan 9, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA14724 | CA | Primary |
Addresses
Primary practice location
506 West Grahan Avenue Suite 107
Lake Elsinore, CA 92530
Mailing address
506 West Grahan Avenue Suite 107
Oliveira Medical Inc.
Lake Elsinore, CA 92530
Phone (951) 471-5116
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA14724 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478131200000",
"number": "1821147208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "506 WEST GRAHAN AVENUE SUITE 107",
"address_2": "OLIVEIRA MEDICAL INC.",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "92530",
"telephone_number": "951-471-5116",
"fax_number": "951-471-5226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "506 WEST GRAHAN AVENUE SUITE 107",
"city": "LAKE ELSINORE",
"state": "CA",
"postal_code": "92530",
"telephone_number": "951-471-5116",
"fax_number": "951-471-5226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "DIANE",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-09",
"last_updated": "2016-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA14724",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Elsinore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.