Healthcare Provider Details

I. General information

NPI: 1528042470
Provider Name (Legal Business Name): KATHRYN LYNN BREWER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN LYNN BREWER MD

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1992 OLD MISSION DR STE 140
SOLVANG CA
93463-2302
US

IV. Provider business mailing address

1992 OLD MISSION DR STE 140
SOLVANG CA
93463-2302
US

V. Phone/Fax

Practice location:
  • Phone: 805-614-5690
  • Fax:
Mailing address:
  • Phone: 805-614-5690
  • Fax: 805-614-5691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18020
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA125955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: