Healthcare Provider Details

I. General information

NPI: 1528392487
Provider Name (Legal Business Name): MS. MICHELLE DENISE BREWER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 OCEAN AVE OMI FAMILY CENTER
SAN FRANCISCO CA
94112-1727
US

IV. Provider business mailing address

8205 SKYLINE CIR
OAKLAND CA
94605-4231
US

V. Phone/Fax

Practice location:
  • Phone: 415-452-2200
  • Fax: 415-334-5712
Mailing address:
  • Phone: 510-207-0711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: