Healthcare Provider Details

I. General information

NPI: 1871428763
Provider Name (Legal Business Name): TANIYA OWENSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CORPORATE CENTER DR STE 210
POMONA CA
91768-2627
US

IV. Provider business mailing address

24213 FAWN ST
MORENO VALLEY CA
92553-6250
US

V. Phone/Fax

Practice location:
  • Phone: 909-618-0974
  • Fax:
Mailing address:
  • Phone: 909-618-0974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: