Provider Demographics
NPI:1730594235
Name:BOWERS, JESSIE SU (MD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:SU
Last Name:BOWERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSIE
Other - Middle Name:
Other - Last Name:GUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC 5124
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-6764
Mailing Address - Fax:
Practice Address - Street 1:12036 SCRIPPS HIGHLANDS DR # 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-5155
Practice Address - Country:US
Practice Address - Phone:858-555-4444
Practice Address - Fax:858-566-3321
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138429208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics