Provider Demographics
NPI:1629639125
Name:BREWER, MARINA MENESCAL (RN)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:MENESCAL
Last Name:BREWER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10314 CAMINITO GOMA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1628
Mailing Address - Country:US
Mailing Address - Phone:859-494-6354
Mailing Address - Fax:
Practice Address - Street 1:1510 S ESCONDIDO BLVD UNIT 104
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6017
Practice Address - Country:US
Practice Address - Phone:859-494-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1121790163W00000X
CA836990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA836990OtherREGISTERED NURSE
KY1121790OtherREGISTERED NURSE