Provider Demographics
NPI:1922261437
Name:BOWEN, GENETE MARIE (LCMT)
Entity Type:Individual
Prefix:MRS
First Name:GENETE
Middle Name:MARIE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N MILLER ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4557
Mailing Address - Country:US
Mailing Address - Phone:805-922-0760
Mailing Address - Fax:805-922-1037
Practice Address - Street 1:120 NORTH MILLER ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-922-0760
Practice Address - Fax:805-922-1037
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist