MEDICARE: JESSIE SU BOWERS 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
1	208000000X	Pediatrics Physician	A138429	CA

General Provider Information

NPI Number	:	1730594235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE SU BOWERS M.D.

Provider Business Mailing Address
First Line	:	3020 CHILDRENS WAY
Second Line	:	MC 5124
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-966-6764
Fax Number	:

Provider Business Practice Location Address
First Line	:	12036 SCRIPPS HIGHLANDS DR # 102
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-5155
Country	:	US
Telephone Number	:	858-555-4444
Fax Number	:	858-566-3321

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

Provider Enumeration Date	:	06/24/2014
Last Update Date	:	05/02/2019

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