Provider Demographics
NPI:1811512122
Name:BOWEN, KESHIA LAIS
Entity type:Individual
Prefix:
First Name:KESHIA
Middle Name:LAIS
Last Name:BOWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 W HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3303
Mailing Address - Country:US
Mailing Address - Phone:626-386-5917
Mailing Address - Fax:626-822-3604
Practice Address - Street 1:325 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3303
Practice Address - Country:US
Practice Address - Phone:626-386-5917
Practice Address - Fax:626-822-3604
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies