Healthcare Provider Details

I. General information

NPI: 1891261202
Provider Name (Legal Business Name): TOSHA MONYETTE OWENS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TOSHA M OWENS-ERVIN

II. Dates (important events)

Enumeration Date: 10/23/2018
Last Update Date: 09/11/2023
Certification Date: 07/30/2023
Deactivation Date: 07/30/2023
Reactivation Date: 09/11/2023

III. Provider practice location address

2085 RUSTIN AVE STE 5
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

313 LENNON LN STE 100
WALNUT CREEK CA
94598-2460
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-2400
  • Fax: 951-509-2404
Mailing address:
  • Phone: 925-289-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: