Provider Demographics
NPI:1669118220
Name:BOWERS, BRAYDEN MATTHEW
Entity type:Individual
Prefix:
First Name:BRAYDEN
Middle Name:MATTHEW
Last Name:BOWERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40020 DAPHNE DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6528
Mailing Address - Country:US
Mailing Address - Phone:951-837-9123
Mailing Address - Fax:
Practice Address - Street 1:40020 DAPHNE DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-6528
Practice Address - Country:US
Practice Address - Phone:951-837-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA703171164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse