Healthcare Provider Details

I. General information

NPI: 1124154265
Provider Name (Legal Business Name): DEBORAH A FOWLER D.O.M., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUNSHINE FOWLER D.O.M.,L.AC.

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10597 BRAGG AVE
GRASS VALLEY CA
95945-5502
US

IV. Provider business mailing address

10597 BRAGG AVE
GRASS VALLEY CA
95945-5502
US

V. Phone/Fax

Practice location:
  • Phone: 530-277-6559
  • Fax:
Mailing address:
  • Phone: 530-277-6559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 9990
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number580
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: