=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902883309
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE OWNBEY CRITES DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2005
-----------------------------------------------------
Last Update Date | 07/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1360 N WINCHESTER BLVD STE 4
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95128-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-241-6967
-----------------------------------------------------
Fax | 408-241-0602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15900 ROCHIN TER
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95032-4820
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-358-0893
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC22426
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------