Provider Demographics
NPI:1518480748
Name:BOWMAN, MARQUITTA ANTOINETTE
Entity Type:Individual
Prefix:MRS
First Name:MARQUITTA
Middle Name:ANTOINETTE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARQUITTA
Other - Middle Name:ANTOINETTE
Other - Last Name:HOWARD BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 N GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3079
Mailing Address - Country:US
Mailing Address - Phone:760-975-9939
Mailing Address - Fax:760-509-9093
Practice Address - Street 1:490 N GRAPE ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3079
Practice Address - Country:US
Practice Address - Phone:760-975-9939
Practice Address - Fax:760-509-9093
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program