Healthcare Provider Details

I. General information

NPI: 1508646126
Provider Name (Legal Business Name): MRS. MARGARET OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3772 TIBBETTS ST
RIVERSIDE CA
92506-2605
US

IV. Provider business mailing address

3772 TIBBETTS ST
RIVERSIDE CA
92506-2605
US

V. Phone/Fax

Practice location:
  • Phone: 951-222-3111
  • Fax: 951-682-7904
Mailing address:
  • Phone: 951-222-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number726696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: