Provider Demographics
NPI:1316168461
Name:ROWE, BEVERLY ELAINE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:ELAINE
Last Name:ROWE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1856
Mailing Address - Country:US
Mailing Address - Phone:323-934-7879
Mailing Address - Fax:
Practice Address - Street 1:2430 6TH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1856
Practice Address - Country:US
Practice Address - Phone:323-934-7879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine