Provider Demographics
NPI:1790861516
Name:BREWER, CYNDI LEE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CYNDI
Middle Name:LEE
Last Name:BREWER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14137 LAKERIDGE CIRCLE
Mailing Address - Street 2:STE C
Mailing Address - City:MAGALIA
Mailing Address - State:CA
Mailing Address - Zip Code:95954-9470
Mailing Address - Country:US
Mailing Address - Phone:530-878-5030
Mailing Address - Fax:530-762-3008
Practice Address - Street 1:14137 LAKERIDGE CIRCLE
Practice Address - Street 2:STE C
Practice Address - City:MAGALIA
Practice Address - State:CA
Practice Address - Zip Code:95954-9470
Practice Address - Country:US
Practice Address - Phone:530-873-5030
Practice Address - Fax:530-762-3008
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
12010778OtherCAQH