Provider Demographics
NPI:1417042904
Name:BOWLES, CYNTHIA A (LSA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:BOWLES
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:PONCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSA
Mailing Address - Street 1:3414 HWY 146 S
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571
Mailing Address - Country:US
Mailing Address - Phone:713-301-0004
Mailing Address - Fax:
Practice Address - Street 1:3414 HWY 146 S
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571
Practice Address - Country:US
Practice Address - Phone:713-301-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00756363AS0400X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant