MEDICARE: DR. TWYMAN RENE OWENS I

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	174400000X	Specialist	G068762	CA

General Provider Information

NPI Number	:	1699844837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TWYMAN RENE OWENS I

Provider Business Mailing Address
First Line	:	403 S LONG BEACH BLVD
Second Line	:	SUITE A
City	:	COMPTON
State	:	CA
Zip	:	90221-3449
Country	:	US
Telephone Number	:	310-635-6181
Fax Number	:	310-635-6196

Provider Business Practice Location Address
First Line	:	403 S LONG BEACH BLVD
Second Line	:	SUITE A
City	:	COMPTON
State	:	CA
Zip	:	90221-3449
Country	:	US
Telephone Number	:	310-635-6181
Fax Number	:	310-635-6196

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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