Provider Demographics
NPI:1710157490
Name:BREWER, SELENA (NP)
Entity Type:Individual
Prefix:MRS
First Name:SELENA
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SAN PABLO STREET
Mailing Address - Street 2:SUITE 4300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5330
Mailing Address - Country:US
Mailing Address - Phone:323-442-5907
Mailing Address - Fax:323-442-5907
Practice Address - Street 1:1520 SAN PABLO STREET
Practice Address - Street 2:SUITE 4300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5330
Practice Address - Country:US
Practice Address - Phone:323-442-5907
Practice Address - Fax:323-442-5907
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002600A363L00000X
CA18777363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFN074ZMedicare UPIN