Provider Demographics
NPI:1316016389
Name:BREUER, ROSWITHA ELISABETH (MD)
Entity Type:Individual
Prefix:
First Name:ROSWITHA
Middle Name:ELISABETH
Last Name:BREUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-2125
Mailing Address - Country:US
Mailing Address - Phone:951-956-2152
Mailing Address - Fax:951-956-2154
Practice Address - Street 1:146 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2125
Practice Address - Country:US
Practice Address - Phone:951-956-2152
Practice Address - Fax:951-956-2154
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A362360Medicaid
CA00A362360Medicaid