Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A156739 | CA |
N | 111NI0900X | Internist | A156739 | CA |
N | 208000000X | Pediatrician | A156739 | CA |
Y | 2080P0205X | Pediatric Endocrinologist | A156739 | CA |
NPI | 1164849899 |
---|---|
Provider Name | Bethany L. Gottesman Bowen |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-4232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2014 |
Last Update Date | 12/08/2021 |