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General NPI Number Information
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NPI Number | 1306354139
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Entity Type | Individual
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Provider Name | WILLIE OWENS III RBT
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Gender | Male
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 01/15/2018
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Provider Practice Location Address
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Address Line | 110 CIVIC CENTER DR STE 207
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City | VISTA
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State | CA
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Zip | 92084-6039
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Country | US
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Telephone | 760-659-6574
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Fax | 760-659-6574
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Provider Business Mailing Address
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Address Line | 726 OAKTREE LN APT 285
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City | SAN MARCOS
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State | CA
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Zip | 92069-6838
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Country | US
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Telephone | 951-909-7244
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-17-40252
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License Number State | CA
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