Provider Demographics
NPI:1295890119
Name:OWENS, JERI E (MD)
Entity type:Individual
Prefix:DR
First Name:JERI
Middle Name:E
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:7580 WEBSTER ST.
Mailing Address - City:GUINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95637
Mailing Address - Country:US
Mailing Address - Phone:707-291-6071
Mailing Address - Fax:
Practice Address - Street 1:233 DOBBINS ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3931
Practice Address - Country:US
Practice Address - Phone:707-469-4540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0340092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34009OtherPHYSICIAN LISCENCE
CAA02771562OtherDEA LISCENCE
CAF17922Medicare UPIN
CAA34009OtherPHYSICIAN LISCENCE