Healthcare Provider Details

I. General information

NPI: 1699961755
Provider Name (Legal Business Name): SUSANA BOWEN RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2007
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 EAST ELDER FALLBROOK HOSPITAL
FALLBROOK CA
92028
US

IV. Provider business mailing address

1408 CRESTHAVEN PLACE
OCEANSIDE CA
92056
US

V. Phone/Fax

Practice location:
  • Phone: 760-731-8451
  • Fax:
Mailing address:
  • Phone: 760-805-0500
  • Fax: 760-842-1764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number480912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: