Provider Demographics
NPI:1518315662
Name:BOWEN, AMANDA (MPH, RD, CDE)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MPH, RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6711 TIARA AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-6031
Mailing Address - Country:US
Mailing Address - Phone:909-615-2171
Mailing Address - Fax:
Practice Address - Street 1:6711 TIARA AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-6031
Practice Address - Country:US
Practice Address - Phone:909-615-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1059335133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered