Provider Demographics
NPI:1326572496
Name:OWEN, MARYELIZABETH (RD)
Entity Type:Individual
Prefix:
First Name:MARYELIZABETH
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065 CANYON CLOSE RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1063
Mailing Address - Country:US
Mailing Address - Phone:323-702-3647
Mailing Address - Fax:
Practice Address - Street 1:1515 N VERMONT AVE
Practice Address - Street 2:4TH FLOOR, EDUCATION DEPT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5337
Practice Address - Country:US
Practice Address - Phone:323-702-3647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1012243133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered