Healthcare Provider Details

I. General information

NPI: 1013636505
Provider Name (Legal Business Name): JEANNETTE ANN BREWER LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40925 COUNTY CENTER DR STE 200
TEMECULA CA
92591-6037
US

IV. Provider business mailing address

40925 COUNTY CENTER DR STE 200
TEMECULA CA
92591-6037
US

V. Phone/Fax

Practice location:
  • Phone: 951-600-6300
  • Fax: 951-600-6377
Mailing address:
  • Phone: 951-600-6300
  • Fax: 951-600-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number23749
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number23749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: