Healthcare Provider Details

I. General information

NPI: 1033812219
Provider Name (Legal Business Name): MICHAEL PETERSON COWLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CENTERPOINTE DR
LA PALMA CA
90623-1050
US

IV. Provider business mailing address

1028 14TH ST APT 1028
SANTA MONICA CA
90403-4243
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A25155
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: