MEDICARE: MS. BEVERLY ELAINE ROWE PHYSICIAN ASSISTANT

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	207R00000X	Internal Medicine Physician	PA18246	CA

General Provider Information

NPI Number	:	1316168461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BEVERLY ELAINE ROWE PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	2430 6TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1856
Country	:	US
Telephone Number	:	323-934-7879
Fax Number	:

Provider Business Practice Location Address
First Line	:	2430 6TH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90018-1856
Country	:	US
Telephone Number	:	323-934-7879
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	02/04/2011

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