Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 20699 | CA |
Y | 103TC0700X | Clinical Psychologist | 20699 | CA |
N | 103TH0004X | Health Psychologist |
NPI | 1356531040 |
---|---|
Provider Name | Jason Edward Owen |
First Address | San Francisco, CA 94143-2211 |
Second Address | San Francisco, CA 94143-2211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2007 |
Last Update Date | 20/09/2013 |