Healthcare Provider Details

I. General information

NPI: 1033014170
Provider Name (Legal Business Name): BOWMAN MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 CAMINO DEL RIO S STE 140
SAN DIEGO CA
92108-3739
US

IV. Provider business mailing address

2727 CAMINO DEL RIO S STE 140
SAN DIEGO CA
92108-3739
US

V. Phone/Fax

Practice location:
  • Phone: 619-335-8377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: AUSTIN DAVIS BOWMAN
Title or Position: PRESIDENT
Credential: MA, LMFT164734
Phone: 619-335-8377