Healthcare Provider Details

I. General information

NPI: 1831403609
Provider Name (Legal Business Name): CHRISTINE OWYANG RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 CALIFORNIA ST G321
SAN FRANCISCO CA
94118-1618
US

IV. Provider business mailing address

PO BOX 254947
SACRAMENTO CA
95865-4947
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6388
  • Fax: 415-600-2376
Mailing address:
  • Phone: 916-854-6975
  • Fax: 916-854-6844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number913795
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: