Provider Demographics
NPI:1790963668
Name:GERALD D BOWMAN
Entity Type:Organization
Organization Name:GERALD D BOWMAN
Other - Org Name:VALLEY ORTHOPEDIC TECHNOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CO/BOCP
Authorized Official - Phone:818-600-2560
Mailing Address - Street 1:16430 VENTURA BLVD
Mailing Address - Street 2:#304
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2115
Mailing Address - Country:US
Mailing Address - Phone:818-600-2560
Mailing Address - Fax:818-600-2561
Practice Address - Street 1:16430 VENTURA BLVD
Practice Address - Street 2:#304
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2115
Practice Address - Country:US
Practice Address - Phone:818-600-2560
Practice Address - Fax:818-600-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-03
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6118650002Medicare NSC