Provider Demographics
NPI:1417086323
Name:OWENS, ARTHUR WAYNE JR
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:WAYNE
Last Name:OWENS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16932 S BERENDO AVE
Mailing Address - Street 2:APT # C
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-5579
Mailing Address - Country:US
Mailing Address - Phone:562-865-3644
Mailing Address - Fax:562-865-5244
Practice Address - Street 1:204 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2623
Practice Address - Country:US
Practice Address - Phone:310-309-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator