Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A83280 | CA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A83280 | CA |
NPI | 1114005741 |
---|---|
Provider Name | Kimberly Ann Bower |
First Address | San Diego, CA 92123-4223 |
Second Address | San Diego, CA 92123-4223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 14/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H99257 | (02) | CA |
WA83280B | (05) | CA |