Healthcare Provider Details

I. General information

NPI: 1417677501
Provider Name (Legal Business Name): ANTHONY J BOWMAN LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

769 W BLAINE ST
RIVERSIDE CA
92507-3970
US

IV. Provider business mailing address

4233 PAPAGO ST
RIVERSIDE CA
92509-6892
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-4705
  • Fax: 951-358-4719
Mailing address:
  • Phone: 951-547-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number238994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: