Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G42573 | CA |
NPI | 1033138110 |
---|---|
Provider Name | Dr. Othella Theresa Owens |
First Address | Los Angeles, CA 90017-4007 |
Second Address | Los Angeles, CA 90017-4007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 02/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G425730 | (05) | CA |
B57152 | (02) |