MEDICARE: DR. OTHELLA THERESA OWENS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	G42573	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033138110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OTHELLA THERESA OWENS MD

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 1604
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4007
Country	:	US
Telephone Number	:	213-250-5470
Fax Number	:	213-250-5468

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 1604
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4007
Country	:	US
Telephone Number	:	213-250-5470
Fax Number	:	213-250-5468

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	05/02/2012

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