Provider Demographics
NPI:1891830394
Name:OWENS, MIA (DIETICIAN)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:DIETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GARNER FIELD RD
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-6210
Mailing Address - Country:US
Mailing Address - Phone:830-278-4453
Mailing Address - Fax:830-278-3427
Practice Address - Street 1:1800 GARNER FIELD RD
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-6210
Practice Address - Country:US
Practice Address - Phone:830-278-4453
Practice Address - Fax:830-278-3427
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT02901133V00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT02901OtherLICENSE NUMBER