Provider Demographics
NPI:1245676246
Name:BOWEN, LISA MARIE (LAC, DIPLAC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 FLANAGAN DR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-5705
Mailing Address - Country:US
Mailing Address - Phone:818-317-0010
Mailing Address - Fax:805-522-4998
Practice Address - Street 1:268 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8223
Practice Address - Country:US
Practice Address - Phone:818-317-0010
Practice Address - Fax:805-522-4998
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133NN1002X
CAAC 14202171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education