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General NPI Number Information
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NPI Number | 1295796688
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Entity Type | Individual
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Provider Name | STEPHANIE D BOWLIN EDD, PA
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Gender | Female
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 191 E ALESSANDRO BLVD
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City | RIVERSIDE
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State | CA
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Zip | 92508-5095
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Country | US
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Telephone | 951-749-5511
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Fax |
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Provider Business Mailing Address
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Address Line | 18064 CLARKE CT
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City | RIVERSIDE
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State | CA
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Zip | 92508-8742
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Country | US
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Telephone | 909-208-7478
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1142
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License Number State | CA
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