Provider Demographics
NPI:1518031418
Name:BOWLER, POLINA (MTOM, LAC)
Entity Type:Individual
Prefix:
First Name:POLINA
Middle Name:
Last Name:BOWLER
Suffix:
Gender:F
Credentials:MTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 WILSHIRE BLVD
Mailing Address - Street 2:100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4547
Mailing Address - Country:US
Mailing Address - Phone:323-936-8512
Mailing Address - Fax:323-936-8512
Practice Address - Street 1:5820 WILSHIRE BLVD
Practice Address - Street 2:100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4547
Practice Address - Country:US
Practice Address - Phone:323-936-8512
Practice Address - Fax:323-936-8512
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6293171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist