Basic Information
| Provider Information | |||||||||
| NPI: | 1508895228 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROUWER | ||||||||
| FirstName: | VALERY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8039 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927288039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149652500 | ||||||||
| FaxNumber: | 7149652581 | ||||||||
| Practice Location | |||||||||
| Address1: | 9900 TALBERT AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927085153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149652500 | ||||||||
| FaxNumber: | 7149652581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 03/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G76049 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.