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General NPI Number Information
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NPI Number | 1114132503
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Entity Type | Individual
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Provider Name | LARRY HOWARD LEE BOWEN ARRT(R) EMT(B)
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 599 TOMALES RD HEALTH SERVICES 'A' SCHOOL
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City | PETALUMA
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State | CA
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Zip | 94952-5002
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Country | US
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Telephone | 707-765-7488
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Fax | 707-765-7495
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Provider Business Mailing Address
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Address Line | 599 TOMALES RD HEALTH SERVICES 'A' SCHOOL
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City | PETALUMA
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State | CA
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Zip | 94952-5002
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Country | US
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Telephone | 707-765-7488
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Fax | 707-765-7495
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | 358321
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License Number State |
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