Provider Demographics
NPI:1447721303
Name:BREWER, CHERYL ANN VALDEZ (RN, PHN)
Entity type:Individual
Prefix:
First Name:CHERYL ANN
Middle Name:VALDEZ
Last Name:BREWER
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:CHERYL ANN
Other - Middle Name:BAUTISTA
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:3851 ROSECRANS ST # Y15
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3851 ROSECRANS ST RM Y15
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3115
Practice Address - Country:US
Practice Address - Phone:619-692-8419
Practice Address - Fax:858-715-6458
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95179625163W00000X
PARN712468163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse