Healthcare Provider Details

I. General information

NPI: 1649375015
Provider Name (Legal Business Name): ANDREA BOWER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 E ALVARADO ST
FALLBROOK CA
92028-2315
US

IV. Provider business mailing address

8151 ARLINGTON AVE SUITE U-V
RIVERSIDE CA
92503-0436
US

V. Phone/Fax

Practice location:
  • Phone: 760-728-3816
  • Fax: 760-728-1542
Mailing address:
  • Phone: 951-588-0861
  • Fax: 951-588-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG036954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: