1912914748 NPI number — ALICE CAMPBELL BROWN-BOWLER

Table of content: ALICE CAMPBELL BROWN-BOWLER (NPI 1912914748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912914748 NPI number — ALICE CAMPBELL BROWN-BOWLER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN-BOWLER
Provider First Name:
ALICE
Provider Middle Name:
CAMPBELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
ALICE
Provider Other Middle Name:
CAMPBELL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.F.T
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912914748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41847 55TH STREET WEST
Provider Second Line Business Mailing Address:
ATTN: GEWL PADILLA, OFFICE MANAGER
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-878-3326
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43535 17TH STREET WEST
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-942-4079
Provider Business Practice Location Address Fax Number:
661-942-3887
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC35909 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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