Connett Brewer, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA59710 Issued in CA

Practice address

4580 Pacific Blvd
Vernon, CA 90058-2208

Phone

(323) 584-0779

Fax

(323) 584-2282

NPI assigned

Feb 14, 2021

Last updated

Sep 16, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1613260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1326631094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4580 PACIFIC BLVD",
            "city": "VERNON",
            "state": "CA",
            "postal_code": "900582208",
            "telephone_number": "323-584-0779",
            "fax_number": "323-584-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4580 PACIFIC BLVD",
            "city": "VERNON",
            "state": "CA",
            "postal_code": "900582208",
            "telephone_number": "323-584-0779",
            "fax_number": "323-584-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREWER",
        "first_name": "CONNETT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-14",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "026643",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA59710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Vernon, CA
• Providers in Vernon, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.