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NPI Code Detail

MEDICARE: DR. JACQUELINE BOWLES M.D.

MEDICARE: DR. JACQUELINE BOWLES M.D.
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
1207R00000XInternal Medicine PhysicianG77735CA

General Provider Information

NPI Number : 1639198260
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELINE BOWLES M.D.
Provider Business Mailing Address
First Line : 711 W FLORENCE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-6105
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 711 W FLORENCE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90044-6105
Country : US
Telephone Number : 323-789-5610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/17/2012

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