Individual
BROOKLYN BOWCUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-S
Contact information
Practice address
4142 ADAMS AVE STE 102, SAN DIEGO, CA 92116-2593
(858) 554-1212
(858) 795-1195
Mailing address
9850 GENESEE AVE STE 320, LA JOLLA, CA 92037-1208
(858) 554-1212
(858) 795-1195
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA61845
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/08/2021
Last updated
01/03/2023
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