Provider Demographics
NPI:1457303869
Name:FOWLER, ELENA (MD)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W NAPA ST
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6559
Mailing Address - Country:US
Mailing Address - Phone:369-215-9091
Mailing Address - Fax:
Practice Address - Street 1:255 W NAPA ST STE M
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6546
Practice Address - Country:US
Practice Address - Phone:369-215-9091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA781192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C206861Medicare ID - Type Unspecified
I31560Medicare UPIN