Healthcare Provider Details

I. General information

NPI: 1235326729
Provider Name (Legal Business Name): GERALD DAVID BOWMAN C.O., BOCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 VANOWEN ST STE 208
VAN NUYS CA
91405-3640
US

IV. Provider business mailing address

15243 VANOWEN ST STE 208
VAN NUYS CA
91405-3640
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1611
  • Fax: 818-996-1612
Mailing address:
  • Phone: 818-600-2560
  • Fax: 818-600-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: