Provider Demographics
NPI:1710124896
Name:BOWSHER, LEAH D (CO)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:D
Last Name:BOWSHER
Suffix:
Gender:F
Credentials:CO
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:D
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CO
Mailing Address - Street 1:11406 LOMA LINDA DR
Mailing Address - Street 2:SUITE 407
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3711
Mailing Address - Country:US
Mailing Address - Phone:909-558-6272
Mailing Address - Fax:909-558-6248
Practice Address - Street 1:11406 LOMA LINDA DR
Practice Address - Street 2:SUITE 407
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3711
Practice Address - Country:US
Practice Address - Phone:909-558-6272
Practice Address - Fax:909-558-6248
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACO004142222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXA0041420Medicaid