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1528133964
MARK DWAYNE FOWLER
LOS ANGELES, CA
NPI
1528133964
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Enumeration Date
2006-11-21
Last Update Date
2007-07-08
Business Address
Mr. MARK DWAYNE FOWLER
1720 E 120TH ST
LOS ANGELES, CA 90059-3052
Phone number: 310-668-3404
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Mailing Address
Mr. MARK DWAYNE FOWLER
2349 LA SALLE AVE
SAN BERNARDINO, CA 92407-2437
Phone number: 909-880-9085
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