MEDICARE: BAY AREA REPRODUCTIVE HEALTHCARE PC

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	174400000X	Specialist	G88634	CA

General Provider Information

NPI Number	:	1407129851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA REPRODUCTIVE HEALTHCARE PC

Provider Business Mailing Address
First Line	:	134 W MAIN ST
Second Line	:	STE 11
City	:	TRINIDAD
State	:	CO
Zip	:	81082-2604
Country	:	US
Telephone Number	:	719-846-6300
Fax Number	:	719-846-9500

Provider Business Practice Location Address
First Line	:	66 BOVET RD
Second Line	:	SUITE 101
City	:	SAN MATEO
State	:	CA
Zip	:	94402-3125
Country	:	US
Telephone Number	:	650-570-6066
Fax Number	:	650-570-6042

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARCI LEE BOWERS
Credential	:	M. D.
Telephone Number	:	719-846-6300

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2012

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