Healthcare Provider Details

I. General information

NPI: 1962312496
Provider Name (Legal Business Name): ANISSA BARBARA OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 RUFFIN CT
SAN DIEGO CA
92123-5399
US

IV. Provider business mailing address

9400 RUFFIN CT
SAN DIEGO CA
92123-5399
US

V. Phone/Fax

Practice location:
  • Phone: 858-598-5035
  • Fax:
Mailing address:
  • Phone: 858-598-5035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: