Healthcare Provider Details

I. General information

NPI: 1245343458
Provider Name (Legal Business Name): STEPHEN GERALD OWENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 VERDUGO BLVD STE 402
GLENDALE CA
91208-1422
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 818-952-0670
  • Fax: 844-364-8194
Mailing address:
  • Phone: 818-952-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA55876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: