Healthcare Provider Details

I. General information

NPI: 1639436538
Provider Name (Legal Business Name): OWENA ELIZABETH CHU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2012
Last Update Date: 11/29/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29099 HOSPITAL ROAD, SUITE 204
LAKE ARROWHEAD CA
92352-4816
US

IV. Provider business mailing address

PO BOX 1515
BLUE JAY CA
92317-1515
US

V. Phone/Fax

Practice location:
  • Phone: 909-744-9451
  • Fax: 909-744-9453
Mailing address:
  • Phone: 909-744-9451
  • Fax: 909-744-9453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number319375
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: