Healthcare Provider Details

I. General information

NPI: 1972630093
Provider Name (Legal Business Name): CONSTANCE MARIE BOWE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 50TH ST PEDIATRIC NEUROLOGY MIND INSTITUTE
SACRAMENTO CA
95817-2308
US

IV. Provider business mailing address

1712 REDWOOD LN
DAVIS CA
95616-1020
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-0258
  • Fax: 916-703-0242
Mailing address:
  • Phone: 530-758-9349
  • Fax: 530-759-8832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberG34387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: