Provider Demographics
NPI:1578277638
Name:OWENS, GREGG (RADIOLOGIC TECHNOLOG)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:RADIOLOGIC TECHNOLOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11284 BELLAIRE ST APT 9
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3000
Mailing Address - Country:US
Mailing Address - Phone:909-800-6356
Mailing Address - Fax:
Practice Address - Street 1:VA HOSPITAL LOMA LINDA 11201 BENTON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-0001
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA450432085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology