MEDICARE: MRS. SELENA BREWER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71002600A	IN
2	363L00000X	Nurse Practitioner	18777	CA

General Provider Information

NPI Number	:	1710157490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SELENA BREWER NP

Provider Business Mailing Address
First Line	:	1520 SAN PABLO STREET
Second Line	:	SUITE 4300
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5330
Country	:	US
Telephone Number	:	323-442-5907
Fax Number	:	323-442-5907

Provider Business Practice Location Address
First Line	:	1520 SAN PABLO STREET
Second Line	:	SUITE 4300
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5330
Country	:	US
Telephone Number	:	323-442-5907
Fax Number	:	323-442-5907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	02/23/2012

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