1790081040 NPI number — EASTER SEALS BAY AREA

Table of content: JEANNE JEWELL BOWSER P.T. (NPI 1053444745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790081040 NPI number — EASTER SEALS BAY AREA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS BAY AREA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790081040
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
391 TAYLOR BLVD
Provider Second Line Business Mailing Address:
STE 250
Provider Business Mailing Address City Name:
PLEASANT HILL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94523-2294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7425 LARKDALE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-828-8857
Provider Business Practice Location Address Fax Number:
925-828-5245
Provider Enumeration Date:
02/03/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MACALOON
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
N
Authorized Official Title or Position:
CONTRACT COMPLIANCE MANAGER
Authorized Official Telephone Number:
510-508-3724

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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