Healthcare Provider Details

I. General information

NPI: 1780864298
Provider Name (Legal Business Name): BOWMAN PSYCHIATRIC, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9777 WILSHIRE BLVD STE. 707
BEVERLY HILLS CA
90212-1910
US

IV. Provider business mailing address

9777 WILSHIRE BLVD STE. 707
BEVERLY HILLS CA
90212-1910
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-4003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberA73152
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: PHILLIP JAMES BOWMAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D
Phone: 310-276-4003