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General NPI Number Information
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NPI Number | 1992714406
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Entity Type | Individual
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Provider Name | KEVIN OWSLEY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 15525 POMERADO RD SUITE A-1
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City | POWAY
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State | CA
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Zip | 92064-2435
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Country | US
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Telephone | 858-673-2530
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28199
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City | SAN DIEGO
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State | CA
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Zip | 92198-0199
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Country | US
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Telephone |
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A98739
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License Number State | CA
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