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General NPI Number Information
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NPI Number | 1326631094
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Entity Type | Individual
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Provider Name | CONNETT BREWER PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/14/2021
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Last Update Date | 09/16/2022
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Provider Practice Location Address
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Address Line | 4580 PACIFIC BLVD
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City | VERNON
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State | CA
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Zip | 90058-2208
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Country | US
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Telephone | 323-584-0779
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Fax | 323-584-2282
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Provider Business Mailing Address
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Address Line | 4580 PACIFIC BLVD
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City | VERNON
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State | CA
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Zip | 90058-2208
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Country | US
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Telephone | 323-584-0779
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Fax | 323-584-2282
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 026643
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA59710
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License Number State | CA
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