Provider Demographics
NPI:1033208939
Name:OWEN, JEFFREY SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:OWEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 MANCHESTER AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4940
Mailing Address - Country:US
Mailing Address - Phone:760-942-1210
Mailing Address - Fax:760-944-9889
Practice Address - Street 1:4405 MANCHESTER AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4940
Practice Address - Country:US
Practice Address - Phone:760-942-1210
Practice Address - Fax:760-944-9889
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9140103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA103T00000XMedicare UPIN
CA103G00000XMedicare UPIN