Provider Demographics
NPI:1205095205
Name:BRECHT, NICHOLAS JAY (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAY
Last Name:BRECHT
Suffix:
Gender:M
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 1:9539 CARNATION AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1506
Mailing Address - Country:US
Mailing Address - Phone:619-964-2449
Mailing Address - Fax:
Practice Address - Street 1:11302A INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5155
Practice Address - Country:US
Practice Address - Phone:562-795-2507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant