Healthcare Provider Details

I. General information

NPI: 1609110105
Provider Name (Legal Business Name): BRIAN ANTHONY ROWE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12291 WASHINGTON BLVD. SUITE 500
WHITTIER CA
90606-2551
US

IV. Provider business mailing address

1 HOAG DR PO BOX 6100
NEWPORT BEACH CA
92663-4162
US

V. Phone/Fax

Practice location:
  • Phone: 562-967-2273
  • Fax: 562-967-2911
Mailing address:
  • Phone: 949-764-1800
  • Fax: 949-764-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21182
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number760402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: