MEDICARE: BOBBY N TOWERY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA14422	CA

General Provider Information

NPI Number	:	1316935026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBY N TOWERY PA

Provider Business Mailing Address
First Line	:	17360 BROOKHURST ST
Second Line	:	ATTN: CREDENTIALING DEPARTMENT
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24411 HEALTH CENTER DR
Second Line	:	SUITE 680
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3651
Country	:	US
Telephone Number	:	949-268-4568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	05/10/2017

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