Provider Demographics
NPI:1548943194
Name:BROWN, ANA LAURA
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LAURA
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:LAURA
Other - Last Name:GARAY GRAJEDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD
Mailing Address - Street 1:6373 FRANKLIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8128
Mailing Address - Country:US
Mailing Address - Phone:915-292-8078
Mailing Address - Fax:
Practice Address - Street 1:CIRCUIPOA CASTANO 10319/29 COUNTRY SENECU
Practice Address - Street 2:
Practice Address - City:CUIDAD JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32472
Practice Address - Country:MX
Practice Address - Phone:915-292-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ51604321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice