Provider Demographics
NPI:1255519757
Name:BOWEN, STEPHANIE (LAC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 N VAN NESS AVE. #4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004
Mailing Address - Country:US
Mailing Address - Phone:310-599-0179
Mailing Address - Fax:
Practice Address - Street 1:435 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3043
Practice Address - Country:US
Practice Address - Phone:323-599-0179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11148171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist