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NPI Code Detail

MEDICARE: CHRISTOPHER BOWERMAN PA

MEDICARE:   CHRISTOPHER  BOWERMAN  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
1363A00000XPhysician Assistant
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1356027007
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER BOWERMAN PA
Provider Business Mailing Address
First Line : 1221 BANGOR ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92106-2407
Country : US
Telephone Number : 619-674-6297
Fax Number :
Provider Business Practice Location Address
First Line : 1221 BANGOR ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92106-2407
Country : US
Telephone Number : 619-674-6297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2023
Last Update Date : 11/14/2024

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