Provider Demographics
NPI:1437494937
Name:OWENS ADDISON, TABATHA M
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:M
Last Name:OWENS ADDISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PALOMAR AIRPORT RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4402
Mailing Address - Country:US
Mailing Address - Phone:858-717-6565
Mailing Address - Fax:
Practice Address - Street 1:2100 PALOMAR AIRPORT RD
Practice Address - Street 2:SUITE 214
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4402
Practice Address - Country:US
Practice Address - Phone:858-717-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist