Healthcare Provider Details

I. General information

NPI: 1265316699
Provider Name (Legal Business Name): HANNAH QUYNH OWENS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FAIRMOUNT AVE
SAN DIEGO CA
92105-1608
US

IV. Provider business mailing address

1282 MARLINE AVE
EL CAJON CA
92021-4906
US

V. Phone/Fax

Practice location:
  • Phone: 619-255-9155
  • Fax:
Mailing address:
  • Phone: 619-760-4761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: