Provider Demographics
NPI:1942446273
Name:JOWKAR, FOROUZ (PA-C)
Entity Type:Individual
Prefix:MS
First Name:FOROUZ
Middle Name:
Last Name:JOWKAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 GALISTEO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2143
Mailing Address - Country:US
Mailing Address - Phone:505-424-9172
Mailing Address - Fax:505-438-1814
Practice Address - Street 1:1925 ASPEN DR
Practice Address - Street 2:#100B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5579
Practice Address - Country:US
Practice Address - Phone:505-424-9172
Practice Address - Fax:505-438-1814
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-0051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant