Provider Demographics
NPI:1962559039
Name:BOWENS, NINA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:MICHELLE
Last Name:BOWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 BORA BORA WAY APT 117
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6881
Mailing Address - Country:US
Mailing Address - Phone:215-593-0597
Mailing Address - Fax:
Practice Address - Street 1:3747 WORSHAM AVE STE 2001
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1731
Practice Address - Country:US
Practice Address - Phone:562-630-8821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188135208600000X
CAA1439012086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery