MEDICARE: DR. STEPHANIE D BOWLIN EDD, 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	PA1142	CA

General Provider Information

NPI Number	:	1295796688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE D BOWLIN EDD, PA

Provider Business Mailing Address
First Line	:	18064 CLARKE CT
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-8742
Country	:	US
Telephone Number	:	909-208-7478
Fax Number	:

Provider Business Practice Location Address
First Line	:	191 E ALESSANDRO BLVD
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-5095
Country	:	US
Telephone Number	:	951-749-5511
Fax Number	:

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	06/06/2016

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