MEDICARE: JONATHAN ERIC BOWENS

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	106S00000X	Behavior Technician	22211723	AZ

General Provider Information

NPI Number	:	1821821331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN ERIC BOWENS

Provider Business Mailing Address
First Line	:	8605 N 59TH AVE APT 1060
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-5400
Country	:	US
Telephone Number	:	562-879-3306
Fax Number	:

Provider Business Practice Location Address
First Line	:	8605 N 59TH AVE APT 1060
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85302-5400
Country	:	US
Telephone Number	:	562-879-3306
Fax Number	:

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

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	08/21/2024

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Directions to “ JONATHAN ERIC BOWENS ” Practice Location

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