Healthcare Provider Details

I. General information

NPI: 1245676246
Provider Name (Legal Business Name): LISA MARIE BOWEN L.AC., DIPL.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 LOMBARD ST
THOUSAND OAKS CA
91360-8223
US

IV. Provider business mailing address

2911 FLANAGAN DR
SIMI VALLEY CA
93063-5705
US

V. Phone/Fax

Practice location:
  • Phone: 818-317-0010
  • Fax: 805-522-4998
Mailing address:
  • Phone: 818-317-0010
  • Fax: 805-522-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 14202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: