Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | G38101 | CA |
N | 2086S0127X | Trauma Surgeon | G38101 | CA |
NPI | 1255374443 |
---|---|
Provider Name | Leon Joseph Owens |
First Address | Carmichael, CA 95608-5548 |
Second Address | Carmichael, CA 95608-0306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A23948 | (02) | CA |