Healthcare Provider Details

I. General information

NPI: 1730535899
Provider Name (Legal Business Name): NICHOLAS BOWEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41593 WINCHESTER RD STE 200
TEMECULA CA
92590-4857
US

IV. Provider business mailing address

41593 WINCHESTER RD STE 200
TEMECULA CA
92590-4857
US

V. Phone/Fax

Practice location:
  • Phone: 619-257-1942
  • Fax:
Mailing address:
  • Phone: 619-257-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA152524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: