Healthcare Provider Details

I. General information

NPI: 1619417060
Provider Name (Legal Business Name): BRYAN BOWMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2017
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 N BELLFLOWER BLVD
LONG BEACH CA
90815-3126
US

IV. Provider business mailing address

2110 N BELLFLOWER BLVD
LONG BEACH CA
90815-3126
US

V. Phone/Fax

Practice location:
  • Phone: 562-346-2222
  • Fax:
Mailing address:
  • Phone: 562-346-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95055588
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005970
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95005970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: