Provider Demographics
NPI:1932166790
Name:BOWERS, JASMINE ANNSHAE (MD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:ANNSHAE
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 SOUTH WINDSOR BLVD
Mailing Address - Street 2:
Mailing Address - City:L.A.
Mailing Address - State:CA
Mailing Address - Zip Code:90005
Mailing Address - Country:US
Mailing Address - Phone:323-528-7406
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:12021 S. WILMINGTON AVENUE
Practice Address - Street 2:MARTIN LUTHER KING. ASC.
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059
Practice Address - Country:US
Practice Address - Phone:310-668-5201
Practice Address - Fax:310-638-8193
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42964207L00000X, 208VP0014X, 208VP0000X
CAA042964207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A429640Medicaid
CA00A429640Medicaid
CAWA42964CMedicare PIN
C35547Medicare UPIN
CABH694ZMedicare PIN
WA42964CMedicare PIN