Provider Demographics
NPI:1831123926
Name:OWEN, RICHARD C (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
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 1:456 E GRAND AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3319
Mailing Address - Country:US
Mailing Address - Phone:760-520-0445
Mailing Address - Fax:760-520-0445
Practice Address - Street 1:456 E GRAND AVE
Practice Address - Street 2:STE 301
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3319
Practice Address - Country:US
Practice Address - Phone:760-520-0445
Practice Address - Fax:760-520-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11606103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP11606Medicare ID - Type UnspecifiedMEDICARE