MEDICARE: MS. ANGELA ROSE POWLEN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA 14383	CA

General Provider Information

NPI Number	:	1194872770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA ROSE POWLEN PA

Provider Business Mailing Address
First Line	:	110 SUTTER ST
Second Line	:	6TH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-4002
Country	:	US
Telephone Number	:	415-291-0480
Fax Number	:	415-201-0489

Provider Business Practice Location Address
First Line	:	110 SUTTER ST
Second Line	:	6TH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-4002
Country	:	US
Telephone Number	:	415-291-0480
Fax Number	:	415-201-0489

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	12/18/2013

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