Healthcare Provider Details

I. General information

NPI: 1992385322
Provider Name (Legal Business Name): ANGELA BREWER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2021
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 MISSION GORGE RD APT 2635
SAN DIEGO CA
92120-2592
US

IV. Provider business mailing address

6850 MISSION GORGE RD APT 2635
SAN DIEGO CA
92120-2592
US

V. Phone/Fax

Practice location:
  • Phone: 702-541-4732
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number699929
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: